Dermoscopy of Subcorneal Hematoma

Abstract

Background. Subcorneal hematoma is a pigmented skin lesion usually occurring on palms or soles after a trauma or sport activity. Clinically, it may exhibit overlapping features with acral melanoma or acral melanocytic nevi, leading to unnecessary excision of this otherwise harmless skin lesion. Objective. The objective was to describe the dermoscopic features in a series of subcorneal hematomas. Methods. Dermoscopic images of 15 subcorneal hematomas were evaluated for the presence of different colors and dermoscopic structures. Results. In our series, a red‐black hue was the most frequent color seen by dermoscopy (40% of the lesions) and a homogeneous pattern of pigmentation was the most frequent dermoscopic structure (53.3%). Remarkably, 40% of the lesions exhibited a parallel‐ridge pattern that is usually found in early melanoma of palms and soles. In 46.7% of the lesions, red‐black globules were additionally seen at the periphery as satellites disconnected from the lesion's body. Only two lesions showed either parallel‐furrow or fibrillar pattern. A scratch test performed in four lesions, allowed complete or partial removal of the pigmentation. Conclusion. Dermoscopic features of subcorneal hematomas may be similar to those observed in acral melanocytic lesions. Nevertheless, in most cases the correct diagnosis can be facilitated by the presence of a red‐black homogeneous pigmentation, often combined with satellite globules. A positive scratch test may be considered as an additional diagnostic clue.

Intracorneal Hematoma Showing Clinical and Dermoscopic Features of Acral Lentiginous Melanoma

“…Dermoscopic features of an intracorneal or subcorneal hematoma may mimic initial acral lentiginous melanoma or melanoma in situ [1, 4, 5]. Typical features of acral melanoma include, for example, colour variegation in a parallel-ridge pattern, border irregularity, and features of regression, which includes colour loss with a bluish-white veiled appearance [1, 4].…”

“…Typical features of acral melanoma include, for example, colour variegation in a parallel-ridge pattern, border irregularity, and features of regression, which includes colour loss with a bluish-white veiled appearance [1, 4]. In hematoma lesions, reddish-black areas of homogenous pigmentation are typically observed, often accompanied by red-brown globules at the periphery, so-called satellite globules [1, 4]. In about 40% of hematomas, parallel-ridge pattern of pigmentation can also be found [1].…”

“…Intra- and subcorneal hematoma, a skin alteration seen palmar and plantar after trauma or physical exercise (usually on the heel as talon noir ), can be challenging to distinguish from in situ or invasive acral lentiginous melanoma [1–3]. Thus, careful examination including dermoscopic and histologic assessment may be necessary to make the correct diagnosis [1–3].…”

“…Thus, careful examination including dermoscopic and histologic assessment may be necessary to make the correct diagnosis [1–3]. We here report a patient with a plantar intracorneal hematoma showing clinical and dermoscopic features of melanoma, leading to surgical excision of the skin alteration.…”

Skin Conditions of Baseball, Cricket, and Softball Players

“…The black puncta can be scraped from the skin, mixed with a small amount of water, and dabbed on to an occult blood screening test to detect the presence of blood [31]. Dermoscopy can help differentiate melanocytic from purpuric lesions, which have red-black homogenous pigmentation bordered by isolated red-black globules [121,122]. Talon and tache noir resolve spontaneously within 2-3 weeks [123].…”