Flat/Pale Brown/Brown

FIGURE 8.1 Color wheel: flat/pale brown/brown.

Take a look at the color wheel in Figure 8.1.

We’ve moved into the world of brown! When we are looking at flat, clinically pale brown, dermoscopically brown lesions, we have to consider malignancies that are early in their development, and this is good, because we want to catch them early! Early malignant melanoma (MM) and lentigo maligna, early basal cell carcinoma (BCC), and early squamous cell carcinoma (SCC) are in our differential. Our benign lesions include early dermatofibroma, early seborrheic keratosis, congenital and junctional nevi, and lentigo.

Benign Lesions

Solar Lentigo

Examples

Figures 8.2, 8.3 and 8.4 show clinically flat, pale brown lesions (A, B) that are dermoscopically brown (C). In all three images, you can appreciate a clear fingerprint pattern with a moth-eaten border. Diagnosis: Solar lentigo.

Bottom line: Benign, biopsy unnecessary.

FIGURE 8.2 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic example of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a fingerprint pattern and moth-eaten borders.

FIGURE 8.3 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a fingerprint pattern and moth-eaten borders.

Figures 8.5, 8.6, 8.7 and 8.8 show clinically flat, pale brown lesions (A, B) that are dermoscopically brown (C). In all three, you can appreciate a homogeneous pattern with a moth-eaten border. Diagnosis: Solar lentigo.

Bottom line: Benign, biopsy unnecessary.

FIGURE 8.4 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a fingerprint pattern and moth-eaten borders.

FIGURE 8.5 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a homogeneous pattern and moth-eaten borders.

Junctional Nevi

FIGURE 8.6 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a homogeneous pattern and moth-eaten borders.

FIGURE 8.7 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a homogeneous pattern and moth-eaten borders.

FIGURE 8.8 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of lentigo (sun spot). A,B: Clinical examples. C: The dermoscopic example shows a homogeneous pattern and moth-eaten borders.

FIGURE 8.9 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of junctional nevi. A,B: Clinical examples. C: The dermoscopic example shows a symmetric reticular network pattern.

Figures 8.9 and 8.10 show clinically flat, pale brown lesions (A, B) that are dermoscopically brown (C). These lesions are characteristic of junctional nevi with a symmetric reticular network pattern. Diagnosis: Junctional nevi.

Bottom line: Benign, biopsy unnecessary.

FIGURE 8.10 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic example of junctional nevi. A,B: Clinical examples. C: The dermoscopic examples show a symmetric reticular network pattern.

Early Seborrheic Keratoses

Examples

Figure 8.11 shows a clinically flat, pale brown lesion (Figure 8.11A, B) that is dermoscopically brown (Figure 8.11C). The coral-like early ridge pattern is characteristic of an early seborrheic keratosis. Diagnosis: Early seborrheic keratoses.

Bottom line: Benign, biopsy unnecessary.

Figure 8.12 shows a clinically flat, pale brown lesion (Figure 8.12A, B) that is dermoscopically brown (Figure 8.12C). We can appreciate the dermoscopic ridges of a seborrheic keratosis with the moth-eaten border of a solar lentigo. This is characteristic of an early seborrheic keratosis evolving from a solar lentigo. Diagnosis: Early seborrheic keratoses.

Bottom line: Benign, biopsy unnecessary.

Figure 8.13 shows a clinically flat, pale brown lesion (Figure 8.13A, B) that is dermoscopically brown (Figure 8.13C). We can see dermoscopic ridges, milia-like cysts, and the sharp borders of a seborrheic keratosis. Additionally, we see the peripheral fingerprint pattern of a lentigo circled in black. This is characteristic of an early seborrheic keratosis evolving from a solar lentigo. Diagnosis: Early seborrheic keratoses.

Bottom line: Benign, biopsy unnecessary.

FIGURE 8.11 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of junctional nevi. A,B: Clinical examples. C: The dermoscopic examples show a coral-like early ridge pattern.

FIGURE 8.12 Clinically flat lesions that are pale brown, with a brown dermoscopic pattern. Review these clinical and dermoscopic examples of an early seborrheic keratosis evolving from a lentigo. A,B: Clinical examples. C: The dermoscopic example shows ridges of a seborrheic keratosis, with the moth-eaten border of a lentigo.

Figure 8.14 shows a clinically flat, pale brown lesion (Figure 8.14A, B) that is dermoscopically brown (Figure 8.14C). Circled in black, we can see the dermoscopic ridges of a seborrheic keratosis, but we still see the moth-eaten border of a lentigo. This is characteristic of an early seborrheic keratosis evolving from a solar lentigo. Diagnosis: Early seborrheic keratoses.

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