Pigmented skin lesions

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, October 2015.


What are pigmented skin lesions?

Pigmented skin lesions refer to lesions that are brown, black or blue in colour, or may be confused with brown or black lesions (for example, vascular lesions, which sometimes look black with the naked eye but under dermatoscopy appear red, purple or blue).

What is the pigment?

The colour of pigmented skin lesions is due to:

  • Melanin
  • Blood
  • Exogenous pigment (for example, tattoo)

What are the possible diagnoses for pigmented skin lesions?

Pigmented skin lesions are most often melanocytic. However, non-melanocytic lesions can also be pigmented, particularly in dark-skinned individuals. Non-melanocytic lesions are keratinocytic, vascular, or reactive.

Melanocytic lesions

Pigmented melanocytic lesions

Keratinocytic lesions

Pigmented keratinocytic lesions

Vascular lesions

Dark-coloured vascular lesions

Reactive pigmentation

Reactive pigmented lesions

Many other lesions and skin conditions are occasionally mistaken for a melanocytic or keratinocytic pigmented skin lesion.

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