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Presentation

Recognizing Amelanotic and Hypomelanotic Melanoma: Key Dermoscopic Clues

Description

The transcript explains how to recognize amelanotic and hypomelanotic melanoma, emphasizing that these lesions are often subtle and easy to miss. A key clinical clue is a small pink lesion with a focal brown area—the “brown dot in a pink spot” pattern—which should raise suspicion for hypomelanotic melanoma. Even without obvious pigment, a symmetric pink patch or macule can still be melanoma, especially when clinical appearance and dermoscopic findings do not match. Important dermoscopic signs include white shiny structures, particularly perpendicular white shiny lines or crystalline structures, which are strongly associated with invasive melanoma and suggest dermal involvement. Other helpful features include scar-like depigmentation, milky red areas, and atypical vascular patterns such as polymorphous vessels, especially combinations of dotted and irregular linear vessels. The speaker notes that thicker melanomas tend to show more prominent and varied vessels. Because non-pigmented Spitz nevi and other lesions like basal cell carcinoma, squamous cell carcinoma, and actinic keratosis can sometimes look similar, the practical message is to biopsy suspicious pink lesions with unusual vessels or white shiny structures, especially in patients with a history of melanoma. The overall takeaway is that “pink is the new black.”

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Conclusions

Amelanotic and hypomelanotic melanomas often present as subtle pink lesions rather than obviously pigmented tumors, so clinicians must maintain suspicion even when lesions look bland.
A focal brown dot within a pink lesion is a key warning sign that should prompt consideration of hypomelanotic melanoma.
When the clinical appearance and dermoscopic features do not match, biopsy is recommended because that discordance may reveal melanoma.
White shiny lines or crystalline structures, especially when arranged perpendicularly, are an important dermoscopic clue for melanoma and often suggest invasive disease.
Scar-like depigmentation and milky red areas are additional dermoscopic features that can support the diagnosis of amelanotic melanoma.
Atypical polymorphous vessels, particularly combinations of dotted and linear irregular vessels, are strongly suspicious for melanoma.
As melanoma becomes thicker, the vascular pattern tends to become more prominent and more chaotic.
Nonpigmented Spitz nevi can closely mimic amelanotic or hypomelanotic melanoma, making biopsy important in older patients with suspicious lesions.
Small or partial biopsies may miss the full diagnosis of these lesions, so complete sampling can be necessary to confirm melanoma.
Overall, the presentation concludes that a pink lesion with unusual vessels and white shiny structures should be treated as melanoma until proven otherwise and biopsied promptly.

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https://academy.dermoscopedia.org/Amelanotic_/hypomelanotic_melanoma
www.academy.dermoscopedia.org
www.dermoscopedia.org