Dermatoscopy and reflectance confocal microscopy aspects of a "nested melanoma of the elderly"

Background. - We report a case of a nested melanoma of the elderly, a recently described entity, and we describe its aspect under confocal reflectance microscopy. Patients and methods. - A 70-year-old woman presented a pigmented lesion of the left leg measuring 2 x 2.5 cm in diameter which was increasing in size. Dermatoscopic examination showed a predominantly globular pattern, with globules of irregular color and distribution. Reflectance confocal microscopy revealed the presence of dense nests at the dermo-epidermal junction with cytologic atypia and pagetoid cells. The histological appearance was overlapping and a diagnosis of nested melanoma of the elderly was made. Comments. - The presence in an older subject of a large pigmented lesion with an irregular globular pattern should be suspected of nested melanoma of the elderly. Reflectance confocal microscopy may be useful in the case of such difficult lesions to proceed with more confidence to surgical excision. (C) 2014 Elsevier Masson SAS. All rights reserved.