Investigate further when pathology doesn’t correlate with dermatoscopy

Melanoma eventually declares itself clinically as a lesion which “breaks the pattern” by virtue of its location, size, shape, unexpected structure/colour, or all of the above.

This is because of the feature of malignant tissue which differentiates it from benign tissue — the fact that the cells have mutated and achieved immortality, such that the lesion will grow continuously and chaotically.

Fortunately, many melanomas spend the early part of their life confined to the epidermis and can present as a pattern-breaking, quite large, in situ lesion before undergoing further mutations which lead to the capability of invasion into the dermis and metastasis.


A 74-year-old man was referred to a GP for treatment of skin malignancies on his back.

A pigmented