Funny looking mole on the chest

A simple lesion looking fairly innocuous but not so on dermoscopy. When I looked at this, my first thought was an ugly duckling which always raises suspicion. Another useful post from Stephen’s blog.


This lesion appeared on a holiday photo from 2 years ago. It had got a bit bigger since then. It wasn’t itching or bleeding, and as you can see does not look very dramatic to the naked eye.

case for IDS (1)

When the dermatoscope is applied, the appearance changes radically.

case for IDS (2)

Using the ‘chaos and clues’ algorithm this is clearly chaotic. As I often say to learners in my clinic, even if you cannot put a name to the structures seen through the dermatoscope, you can count the number of structures and clearly there are many structures here. Chaos on dermoscopy is defined as multiple colours, multiple structures, and lack of symmetry.

I can see 4 four colours (brown, blue, red, black) arranged asymmetrically, plus irregular dots and clods, featureless blue and red areas, and angulated lines (slightly easier to see if you squint at the picture). Too many colours, too many structures.


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