Elevated/Pink-Clear/Yellow
Step 1: Is the lesion flat or raised? Elevated (Occasionally Flat)
Step 2: What color is the lesion on clinical assessment? Pink or Clear
Step 3: What is the dermoscopic color? Yellow
Step 4: Is further elucidation needed to decide whether to biopsy or not? Yes
Take a look at the color wheel in Figure 18.1.
Here we will be looking at two benign lesions: sebaceous hyperplasia and milia/acne.
Both of these lesions have been confused with basal cell carcinoma. This chapter will help you learn how to never confuse them again!
Sebaceous Hyperplasia
Pearls
Elevated/Pink-Clear/Yellow
These pink- or skin-colored papules often have a central dell or depression.
Remember that we first encountered these in Chapter 7 Elevated/Pink-clear/Multicolored. We will revisit them here, as they can often be yellow dermoscopically.
These lesions are mostly elevated, but occasionally, you’ll run across a flat one.
Irritated sebaceous hyperplasia can clinically look like BCCs and will be important to distinguish by identifying patterns.
Step 4 Patterns:
Yellow-white lobular structures, resembling popcorn
Serpentine radial vessels, resembling a crown
These radial vessels typically do not cross the midline.
Central indentation or dell
Bottom line: Benign, biopsy not necessary.
Examples
Figure 18.2 reminds us of the patterns that we see with sebaceous hyperplasia. Clinically, these elevated, pink or clear lesions have a yellow-white lobular dermoscopic pattern. These lobular structures can look like popcorn, with serpentine radial vessels or crown vessels and central dell.
Figures 18.3 and 18.4 are examples of clinically elevated, pink or skin-colored lesions (Figure 18.3A-D) with a yellow-white dermoscopic pattern (Figure 18.4A-D). You can appreciate the yellow-white lobular popcorn pattern, with the radial serpentine vessels in all four lesions. Figures A, B, and C also have the central dell.