Practical Dermoscopy
Fast-Growing Pigmented Nodular Lesions
Lesiones nodulares pigmentadas de rápido crecimiento
L. Padilla-España
, I. Fernández-Canedo, N. Blázquez-Sánchez
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Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
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Padilla-España, I. Fernández-Canedo, N. Blázquez-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:2 [ 0 => "laura.padilla.espana@gmail.com" 1 => "laupadesp@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Fernández-Canedo" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Blázquez-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones nodulares pigmentadas de rápido crecimiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 487 "Ancho" => 1300 "Tamanyo" => 140452 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Comment</span><p id="par0005" class="elsevierStylePara elsevierViewall">The images show rapidly growing, pigmented nodular lesions in which dermoscopy was very helpful in establishing the diagnosis and, thus, the prognosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The first case shows a symmetrical lesion with slightly unclear borders, corresponding to a hemosiderotic dermatofibroma. On dermoscopy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), a polychromic lesion (light and dark brown, red, white, and blue) can be seen with a homogeneous, erythematous-brownish area and a delicate light-brown network peripherally. Attention is drawn to the presence of a rainbow pattern in the central area. This pattern can only be observed with polarized light, with or without contact, and it is thought to be due to an interaction between polarized light and certain skin structures. The finding has been described mainly in Kaposi sarcoma lesions,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> though also in other inflammatory<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> and neoplastic<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> diseases.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy of hemosiderotic dermatofibroma has also been reported to show the presence of whitish birefringent structures as a result of the passage of polarized light through increased dermal fibrosis,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> and the presence of the rainbow phenomenon has been described.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The second case is of a pigmented nodular lesion that, on dermoscopy is seen to be bichromic (white, blackish-blue), with a scaly crust, foci of ulceration at its superior pole, and pigmented macules at its inferior pole (Fig.<span class="elsevierStyleHsp" style=""></span>2B). The most relevant of these dermoscopic findings were the presence of a blue-gray veil and multiple whitish birefringent areas compatible with chrysalis structures. These signs are suggestive of nodular melanoma.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Chrysalis structures have been described in dermoscopy of melanocytic and nonmelanocytic lesions under polarized light.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In nodular melanoma, a hypomelanotic/amelanotic lesion is usually seen. In pigmented melanomas, as in our case, the presence of atypical peripheral globules and a whitish-blue veil are the most significant dermoscopic findings. In addition, when chrysalis structures are observed in a melanocytic lesion, spitzoid lesions such as the Spitz nevus, the Reed nevus, and spitzoid melanoma must be included in the differential diagnosis; a malignant lesion must always be excluded, particularly in adult patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we have presented 2 lesions that can be a diagnostic challenge because of their clinical similarities. Dermoscopy played a key role in the investigation of these lesions and revealed different birefringent structures: chrysalis structures in one and a rainbow pattern in the other. The rainbow sign has only recently been described in the literature and its diagnostic value is still to be determined.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Comment" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Padilla-España L, Fernández-Canedo I, Blázquez-Sánchez N. Lesiones nodulares pigmentadas de rápido crecimiento. Actas Dermosifiliogr. 2015;106:505–506.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 505 "Ancho" => 1300 "Tamanyo" => 163212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, A pigmented nodular lesion of 10<span class="elsevierStyleHsp" style=""></span>mm diameter that had appeared on the right shoulder of a 54-year-old man 8 months earlier. B, A pigmented nodular lesion of 12<span class="elsevierStyleHsp" style=""></span>mm diameter in the left scapular region of a 67-year-old woman; the patient was uncertain when the lesion had first appeared but reported that it had grown rapidly in recent months.</p>" ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 487 "Ancho" => 1300 "Tamanyo" => 140452 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rainbow pattern in Kaposi's sarcoma under polarized dermoscopy: A dermoscopic pathological study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.T. 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| 2023 Abril | 71 | 20 | 91 |
| 2023 Marzo | 65 | 22 | 87 |
| 2023 Febrero | 62 | 33 | 95 |
| 2023 Enero | 54 | 32 | 86 |
| 2022 Diciembre | 77 | 40 | 117 |
| 2022 Noviembre | 46 | 25 | 71 |
| 2022 Octubre | 54 | 23 | 77 |
| 2022 Septiembre | 56 | 46 | 102 |
| 2022 Agosto | 43 | 38 | 81 |
| 2022 Julio | 30 | 36 | 66 |
| 2022 Junio | 22 | 34 | 56 |
| 2022 Mayo | 74 | 31 | 105 |
| 2022 Abril | 93 | 32 | 125 |
| 2022 Marzo | 64 | 59 | 123 |
| 2022 Febrero | 95 | 34 | 129 |
| 2022 Enero | 80 | 41 | 121 |
| 2021 Diciembre | 56 | 40 | 96 |
| 2021 Noviembre | 49 | 44 | 93 |
| 2021 Octubre | 56 | 49 | 105 |
| 2021 Septiembre | 59 | 34 | 93 |
| 2021 Agosto | 47 | 25 | 72 |
| 2021 Julio | 46 | 32 | 78 |
| 2021 Junio | 46 | 16 | 62 |
| 2021 Mayo | 42 | 29 | 71 |
| 2021 Abril | 68 | 55 | 123 |
| 2021 Marzo | 79 | 14 | 93 |
| 2021 Febrero | 89 | 21 | 110 |
| 2021 Enero | 30 | 17 | 47 |
| 2020 Diciembre | 29 | 20 | 49 |
| 2020 Noviembre | 30 | 15 | 45 |
| 2020 Octubre | 21 | 4 | 25 |
| 2020 Septiembre | 18 | 11 | 29 |
| 2020 Agosto | 28 | 12 | 40 |
| 2020 Julio | 23 | 14 | 37 |
| 2020 Junio | 40 | 33 | 73 |
| 2020 Mayo | 27 | 15 | 42 |
| 2020 Abril | 31 | 19 | 50 |
| 2020 Marzo | 27 | 12 | 39 |
| 2020 Febrero | 6 | 0 | 6 |
| 2020 Enero | 2 | 7 | 9 |
| 2019 Diciembre | 8 | 9 | 17 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 10 | 4 | 14 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 4 | 13 | 17 |
| 2019 Mayo | 6 | 32 | 38 |
| 2019 Abril | 2 | 22 | 24 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 5 | 3 | 8 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 2 | 3 | 5 |
| 2018 Noviembre | 2 | 3 | 5 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Febrero | 41 | 5 | 46 |
| 2018 Enero | 45 | 3 | 48 |
| 2017 Diciembre | 49 | 5 | 54 |
| 2017 Noviembre | 33 | 5 | 38 |
| 2017 Octubre | 38 | 7 | 45 |
| 2017 Septiembre | 33 | 13 | 46 |
| 2017 Agosto | 30 | 11 | 41 |
| 2017 Julio | 22 | 12 | 34 |
| 2017 Junio | 33 | 6 | 39 |
| 2017 Mayo | 35 | 8 | 43 |
| 2017 Abril | 25 | 6 | 31 |
| 2017 Marzo | 30 | 47 | 77 |
| 2017 Febrero | 19 | 11 | 30 |
| 2017 Enero | 16 | 5 | 21 |
| 2016 Diciembre | 23 | 10 | 33 |
| 2016 Noviembre | 32 | 12 | 44 |
| 2016 Octubre | 21 | 14 | 35 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 7 | 1 | 8 |
| 2016 Junio | 11 | 1 | 12 |
| 2016 Mayo | 13 | 15 | 28 |
| 2016 Abril | 7 | 0 | 7 |
| 2016 Marzo | 10 | 0 | 10 |
| 2016 Febrero | 7 | 1 | 8 |
| 2016 Enero | 2 | 2 | 4 |
| 2015 Diciembre | 0 | 2 | 2 |
| 2015 Septiembre | 0 | 1 | 1 |
| 2015 Agosto | 0 | 3 | 3 |
| 2015 Julio | 0 | 2 | 2 |
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