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Melanoma — SCE Dermatology MCQ

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HardSkin CancerMelanomaSCE Dermatology

An asymmetric pigmented lesion contains irregular blue-grey peppering and sharply demarcated white scar-like areas on dermoscopy. Which paired histological correlate best explains these structures?

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Correct answer: B — Dermal melanophages producing peppering and fibrosis producing scar-like depigmentation

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

D is correct. Blue-grey peppering reflects melanin within dermal melanophages after pigment incontinence, while white scar-like depigmentation corresponds to fibrosis and loss of lesional pigment. Together they form dermoscopic regression structures. Extensive or irregular regression in an asymmetric melanocytic lesion can add to concern for melanoma and should be interpreted with the complete pattern rather than used in isolation. Junctional nests create network or globules, capillary loops are vascular structures, sebaceous lobules are yellow, and keratin, acanthosis or calcification do not explain this paired pattern. Histological regression may also complicate assessment of the lesion’s former extent.

Reference: DermNet dermoscopy of melanoma course: https://dermnetnz.org/cme/dermoscopy-course/dermoscopy-of-melanoma