Benign simulators of melanoma on dermoscopy – black colour does not always indicate melanoma
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The Center For Cancer Prevention and Therapy, Katowice, Poland
Department of Conventional and Intraoperative Radiotherapy Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland
Corresponding author
Grazyna Kaminska-Winciorek   

Department of Conventional and Intraoperative Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
J Pre Clin Clin Res. 2013;7(1):6-12
Simulators of malignant melanoma comprise a heterogeneous group of melanocytic and nonmelanocytic lesions of the skin. They are mainly characterized by the occurrence of black or blue-black colors – both in clinical diagnosis as on dermoscopy. Therefore the proper recognition of this cases is extremely needed in daily general practice of many specialties’ doctors.

The aim of the paper is the presentation of the most popular and possible simulators of malignant melanoma which have been accompanied by the occurrence of a black coloring on dermoscopy. This review presents a di¬erential diagnosis of melanoma simulators and malignant melanoma based on Pubmed databes and own clinical experience.

State of knowledge:
Paper reviews main potential benign melanoma-simulators such as melanocytic nevi (black nevus, blue nevus, and Spitz/Reed nevus), neoplasmatic proliferations (pigmented basal cell carcinoma – BCC and Kaposi sarcoma), vascular and hemorrhagic changes (labial venous lake, thrombosed hemangioma, pyogenic granuloma, subcorneal hematoma, and angiokeratoma), hyperkeratotic proliferations (seborrheic keratosis and melanoacanthoma) and miscellaneous (black comedo, cosmetic and posttraumatic tattoos). Authors described the main clinical and dermoscopic features of benign melanoma simulators.

The knowledge about melanoma simulators can reduce the number of surgical procedures and will help not only dermatologists, but also the professionals of other specialties, such as general practitioners, oncologists and also the paediatricians.

Tomasini C, Broganelli P, Pippione M. Targetoid hemosiderotic nevus. A trauma-induced simulator of malignant melanoma. Dermatology 2005; 210: 200 205.
Scope A, Benvenuto-Andrade C, Agero AL, Marghoob AA. Nonmelanocytic lesions defying the two-step dermoscopy algorithm. Dermatol Surg. 2006; 32: 1398–1406.
Neila J, Soyer HP. Key points in dermoscopy for diagnosis of melanomas, including di_cult to diagnose melanomas, on the trunk and extremities. J Dermatol. 2011; 38: 3–9.
Terushkin V, Dusza SW, Scope A, Argenziano G, Bahadoran P, Cowell L, et. al. Changes observed in slow-growing melanomas during longterm dermoscopic monitoring. Br J Dermatol. 2012; 166: 1213–1220.
Argenziano G, Longo C, Cameron A, Cavicchini S, Gourhant JY, Lallas A, et al. Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma. Br J Dermatol. 2011; 165: 1251–1255.
Carlos-Ortega B, de Oca-Monroy FM, Isyta-Morales A. [Dermoscopy _ndings in malignant skin melanoma with metastases. A case report].Rev Med Inst Mex Seguro Soc. 2009; 47: 73–76.
Minagawa A, Koga H, Sakaizawa K, Sano K, Saida T. Dermoscopic and histopathological _ndings of polymorphous vessels in amelanotic cutaneous metastasis of pigmented cutaneous melanoma. Br J Dermatol. 2009; 160: 1134–1136.
Oiso N, Kawada A. _e dermoscopic features in infantile hemangioma. Pediatr Dermatol. 2011; 28: 591–593.
Kaminska-Winciorek G. Digital dermatology.1st ed. Cornetis (Wroclaw), 2008.
Moscarella E, Zalaudek I, Buccini P, Cota C, Catricalà C, Argenziano G. Dermoscopy and confocal microscopy of thrombosed hemangiomas. Arch Dermatol. 2012; 148: 410.
Coates D, Bowling J. Dermoscopy is not always helpful in the diagnosis of vascular lesions. Australas J Dermatol. 2010; 51: 292–294.
Wang SQ, Katz B, Rabinovitz H, Kopf AW, Oliviero M. Lessons on dermoscopy #7. _e diagnosis was thrombosed hemangioma. Dermatol Surg. 2000; 26: 891–892.
Zaballos P, Daufí C, Puig S, Argenziano G, Moreno-Ramírez D, Cabo H, et al. Dermoscopy of solitary angiokeratomas: a morphological study. Arch Dermatol. 2007; 143: 318–25.
Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J, Llambrich A, et al. Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010; 163: 1229–1237.
Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic _ndings in pyogenic granuloma Br J Dermatol. 2006; 154: 1108–1111.
Zaballos P, Rodero J, Serrano P, Cuellar F, Guionnet N, Vives JM. Pyogenic granuloma clinically and dermoscopically mimicking pigmented melanoma Dermatol Online J. 2009; 15: 10.
Hu SC, Ke CL, Lee CH, Wu CS, Chen GS, Cheng ST. Dermoscopy of Kaposi’s sarcoma: areas exhibiting the multicoloured ‘rainbow pattern’. J Eur Acad Dermatol Venereol. 2009; 23: 1128–1132.
Zalaudek I, Argenziano G, Soyer HP, Saurat JH, Braun RP. Dermoscopy of subcorneal hematoma. Dermatol Surg. 2004; 30: 1229–1232.
Zaballos P, Llambrich A, Ara M, Olazarán Z, Malvehy J, Puig S. Dermoscopic _ndings of haemosiderotic and aneurysmal dermato_bro ma: report of six patients. Br J Dermatol. 2006; 154: 244–250.
Kilinc Karaarslan I, Gencoglan G, Akalin T, Ozdemir F. Di_erent dermoscopic faces of dermato_bromas. J Am Acad Dermatol. 2007; 57: 401–406.
Scalvenzi M, Balato A, De Natale F, Francia MG, Mignogna C, De Rosa G. Hemosiderotic dermato_broma: report of one case. Dermatology 2007; 214: 824.
Blum A, Jaworski S, Metzler G, Bauer J. Lessons on dermoscopy: Dermoscopic pattern of hemosiderotic dermato_broma. Dermatol Surg. 2004; 30: 1354–1355.
Zalaudek I, Manzo M, Savarese I, Docimo G, Ferrara G, Argenziano G. _e morphologic universe of melanocytic nevi. Semin Cutan Med Surg. 2009; 28: 149–156.
Zalaudek I, Docimo G, Argenziano G. Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi. Arch Dermatol. 2009; 145: 816–826.
Kaminska-Winciorek G, Spiewak R. Basic dermoscopy of melanocytic lesions for beginners. Postepy Hig Med Dosw. (Online). 2011; 65: 501– 508.
Kaminska-Winciorek G. Ultaviolet exposure and melanocytic nevi in children- prophylaxis and management. In: Otto-Buczkowska E. What’s new in pediatrics? 2nd ed. Wroclaw Cornetis, 2011.p. 491–501.
Kaminska-Winciorek G. Melanocytic nevi in children in its clinical and dermoscopic aspects. Dermatol Dziecieca. 2011; 1: 68–74.
Ferrara G, Soyer HP, Malvehy J, Piccolo D, Puig S, Sopena J, et al. _e many faces of blue nevus: a clinicopathologic study. J Cutan Pathol. 2007, 34: 543–551.
Tsunemi Y, Saeki H, Tamaki K. Blue naevus with pigment network-like structure on dermoscopy. Acta Derm Venereol. 2008; 88: 412–413.
Samimi M, Perrinaud A, Naouri M, Maruani A, Perrodeau E, Vaillant L, et al. High-resolution ultrasonography assists the di_erential diagnosis of blue naevi and cutaneous metastases of melanoma. Br J Dermatol. 2010; 163: 550–556.
Requena C, Requena L, Kutzner H, Sánchez Yus E. Spitz nevus: a clinicopathological study of 349 cases. Am J Dermatopathol. 2009; 31: 107–116.
Ferrara G, Zalaudek I, Savarese I, Scalvenzi M, Argenziano G. Pediatric atypical spitzoid neoplasms: a review with emphasis on ‘red’ (‘spitz’) tumors and ‘blue’ (‘blitz’) tumors. Dermatology. 2010; 220: 306–10.
Patrizi A, Giacomini F, Savoia F, Misciali C, Neri I. Targetoid hemosiderotic naevus. J Eur Acad Dermatol Venereol. 2009; 23: 493–494.
Kaminska-Winciorek G, Spiewak R. Tips and tricks in the dermoscopy of pigmented lesions. BMC Dermatol. 2012; 12: 14.
Menzies SW. Dermoscopy of pigmented basal cell carcinoma. Clin Dermatol. 2002; 20: 268–269.
Takenouchi T. Key points in dermoscopic diagnosis of basal cell carcinoma and seborrheic keratosis in Japanese. J Dermatol. 2011; 38: 59–65.
de Giorgi V, Massi D, Salvini C, Mannone F, Carli P. Pigmented seborrheic keratoses of the vulva clinically mimicking a malignant melanoma: a clinical, dermoscopic-pathologic case study. Clin Exp Dermatol. 2005; 30: 17–19.
Shankar V, Nandi J, Ghosh K, Ghosh S. Giant melanoacanthoma mimicking malignant melanoma. Indian J Dermatol. 2011; 56: 79–81.
Rossiello L, Zalaudek I, Ferrara G, Docimo G, Giorgio CM, Argenziano G. Melanoacanthoma simulating pigmented Spitz nevus: an unusual dermoscopy pitfall. Dermatol Surg. 2006; 32: 735–737.
Kaminska-Winciorek G. Letter: “Blue Pseudo-Veil Sign” – a New Dermo scopic Term? Dermatol Surg. 2012; 38:1574–1575.
Kaminska-Winciorek G, Spiewak R. [Dermoscopy in aesthetic medicine]. Polish Journ Cosmetol. 2011; 14: 17–26.
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