Elevated/Pale Brown/Brown
 FIGURE 10.1 Color wheel: elevated/pale brown/brown. |
Step 1: Is the lesion flat or raised? Elevated
Step 2: What color is the lesion on clinical assessment? Pale Brown
Step 3: What is the dermoscopic color? Brown
Step 4: Is further elucidation needed to decide whether to biopsy or not? No
Take a look at the color wheel in Figure 10.1.
What’s missing on the differential? Malignant lesions!
Elevated/pale brown/brown are your best friends, your bread and butter, your walk in the park. If you evaluate a lesion and determine it is a clinically elevated, pale brown, and dermoscopically brown lesion, you are done. You will not need to biopsy these lesions.
Our differential includes only benign entities, congenital and intradermal nevi, as well as seborrheic keratosis. There are no malignancies on our list.
This being said, there are always exceptions to rules, and there may come a day that you in fact will find a malignancy in this category. However, in the overwhelming majority of cases, malignancy need not be of concern.
Let’s look at some examples in order to show why we don’t need to biopsy these lesions and can move on in the examination of our patients. Pattern evaluation will not be necessary for these lesions.
 FIGURE 10.2 A-C: Clinically elevated lesions that are pale brown. A-C show a brown dermoscopic pattern. These are examples of three congenital nevi. D-F: The dermoscopic pattern of the corresponding figures D-F shows a dot/globular pattern. |
Examples
Figure 10.2A-C shows three clinically elevated, pale brown lesions (A-C). Figure 10.2D-F shows their dermoscopic counterparts. We see brown dermoscopically. You can also immediately notice the globular dot pattern, but the pattern is not necessary in this case. These are congenital nevi. Diagnosis: Congenital nevi.
Bottom line: Benign, biopsy not necessary.
Figures 10.3, 10.4, 10.5 and 10.6 show more examples of clinically elevated, pale brown (A, B) lesions that are dermoscopically brown (C). Remember that congenital nevi will look similar to other
nevi surrounding them. The pattern is unnecessary to evaluate, but you can appreciate our benign melanocytic patterns, including diffuse reticular, globular, and homogenous patterns. Diagnosis:
nevi surrounding them. The pattern is unnecessary to evaluate, but you can appreciate our benign melanocytic patterns, including diffuse reticular, globular, and homogenous patterns. Diagnosis:
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