Q. How does amelanotic melanoma look like?

Answered by
Dr. Atishay Bukharia
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 21, 2020

Hello doctor,

Does this lesion in my lower back (pink) appear to be worrisome for amelanotic melanoma? It now appears flesh-colored. Pictures attached.



Welcome to icliniq.com.

I have seen the pictures. (attachment removed to protect patient identity).

Yes, they are looking like melanoma. Signs of vascularization in the previous nevus is suggestive of melanoma. Kindly consult a local dermatologist as dermoscopic and histological examinations are required to confirm the diagnosis.

Thank you doctor,

As far as I know, it is not a previous nevus, though. Unless you can tell somehow that it was? I thought arborizing or branched serpentine vessels were much more commonly found in basal cell carcinomas, and amelanotic melanoma was more commonly polymorphous vessels.



Welcome back to icliniq.com.

Actually amelanotic melanoma can also occur from an intradermal nevus, so it is not necessary to present over the skin. The use of dermoscopy in clinical practice will improve the identification of skin lesions although, unfortunately, it will not guarantee a diagnostic accuracy of 100%. At times this BCC (basal cell carcinoma) pattern will be difficult to differentiate from amelanotic. Melanoma and the final diagnosis should rest on the histopathologic evaluation of the lesion.

Other differentials include microvenular hemangioma, angioma serpiginosum, blue rubber bleb nevus syndrome. Dermoscopic finding of Spitz nevi is also the same as you had sent to me. So I would highly recommend you to go for histopathological examination.

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