Pink patch reveals a surprise diagnosis

A Pink lesion on the back is usually a superficial BCC or SCC in situ, but occasionally a surprise result is found after a punch biopsy is performed. This was an amelanotic melanoma in an immunosuppressed patient who had received a transplant. The dark area in the centre is the result of the punch biopsy. The only way to diagnose these before biopsy is to use a dermatoscope and look at the vessels. In a superficial BCC, they are linear serpentine. In SCC in situ, they are dot- or glomerular-like; while in amelanotic melanoma, they are polymorphic with dot vessels. There may be an argument to say why bother with the dermatoscope as you will be biopsying it anyway, but some doctors don’t like being surprised!