Compelling clues in the peripheral clods

A 56-year-old woman, with no risk factors for melanoma, presents for an annual skin examination.

A lesion over her right clavicle is noted (see figure A).

There are no clinical features of concern macroscopically.

The lesion is examined dermatoscopically (see figure B) and found to be symmetrical, with none of the specific clues to malignancy as defined in any published algorithm.

There is, however, a dermatoscopic clue to change in the form of peripheral clods.

Dermoscopy
Figure A. Lesion over right clavicle.
Figure B. Lesion examined dermatoscopically.

 

This would be an unremarkable feature in an