Grey dots, clods, circles or lines

Grey dots and clods are a weak clue to melanoma. Grey dots can be seen in LPLP (Lichen planus like keratosis), Pigmented solar keratosis, Solar lentigo and Lentigo maligna and Pigmented IEC (Bowen's disease), Melanoma and Clark nevi. They usually represent melanin in melanophages in the dermis and are considered a feature of regression or immune attack on a lesion. I still find it wise to excise any pigmented lesion with a network and grey dots to exclude melanoma.

Often Seborrhoeic keratoses and solar lentigos will show grey dots at an advancing edge indicating clinical regression. If you are sure the background lesion is benign then re assure the patient but if there is any doubt then shave the lesion for histology. Dont do a punch biopsy because tissue being examined then is too little and variable.

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Grey circles  Circles are what we see when the rete ridges are thickened by acanthosis. In the normal network the circles abut each other but the epidermal thickening of acanthosis separates them again. Grey circles are a feature of lentigo maligna, melanoma, pigmented IEC, pigmented solar keratosis and LPLK.
They are also not a strong clue for melanoma except on the face with Lentigo maligna.

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Grey Lines   These often take the shape of Polygons . This pattern can be useful in diagnosing lentiginous melanoma particularly off the face in chronic sun damaged skin.

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