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The patient A 56-year-old Caucasian woman, with skin phototype III, presented with an asymptomatic, slow-growing, gray-black plaque on her nose. The lesion had appeared almost 6 months prior, was 10 × 5 mm in size and presented with a paler, raised and scaly central area (Figure 1). This area could be hardly differentiated from ulceration, however, that was excluded on histology. Dermatoscopy with a non-contact polarizing dermatoscope revealed an unspecific pattern, structureless and asymmetric (Figure 2), characterized by blue-gray radial lines, disposed centrifugally at the periphery of a structureless scaly center, with some blood spots. Other dermatoscopic features were few peripheral ectatic linear vessels in the lower and less pigmented area, a few discrete blue-gray blotches and a pink-white halo around the lesion. No prior topical treatment was used before our consultation. The diagnoses proposed to the pathologist included basal cell carcinoma, adnexal tumor and melanoma, but the lesion was described as non-specific. Surgical excision was performed with 2 mm margins. Histopathologic examination revealed an aggregation of atypical epithelial cells in the dermis (Figure 3), severe solar eosinophilic elastosis, squamous eddy, atypical and necrotic epithelial squamous cells and pigmented deposits of melanin (Figure 4).

No abstract