Aspect en dermatoscopie et en microscopie confocale par réflectance d'un mélanome en thèques du sujet âgé

Background.-We report a case of a nested melanoma of the elderly, a recently describedentity, and we describe its aspect under confocal reflectance microscopy.Patients and methods.-A 70-year-old woman presented a pigmented lesion of the left legmeasuring 2 × 2.5 cm in diameter which was increasing in size. Dermatoscopic examinationshowed a predominantly globular pattern, with globules of irregular color and distribution.Reflectance confocal microscopy revealed the presence of dense nests at the dermo-epidermaljunction with cytologic atypia and pagetoid cells. The histological appearance was overlappingand a diagnosis of nested melanoma of the elderly was made.Comments.-The presence in an older subject of a large pigmented lesion with an irregularglobular pattern should be suspected of nested melanoma of the elderly. Reflectance confocalmicroscopy may be useful in the case of such difficult lesions to proceed with more confidenceto surgical excision.