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A Pinkish-Blue Exophytic Nodule on the Arm of an Elderly Man: A Quiz. Melanocytic matricoma.

An otherwise healthy man in his 60s was concerned about an asymptomatic nodule on his left arm that showed rapid growth (Fig. 1A). The patient stated that it had been growing for approximately 2 months, and he was certain of the absence of any prior lesion at that site. Clinical examination revealed a 1-cm, firm, exophytic nodule, with colour ranging from pink to blue, with well-defined and regular borders, indolent and homogeneously hard on palpation, seated on photo-damaged skin. No ulceration or peripheral macular pigmentation was observed to extend beyond the base of the lesion. Dermoscopy revealed homogeneous blue pigmentation, patchy brown, scattered pigmentation and hairpin-like vessels at the borders, sometimes extending into whitish structureless areas (Fig. 1B). An excisional biopsy specimen was obtained showing a well-circumscribed and asymmetrically pigmented dermal nodule composed of variably pigmented basaloid cells, admixed with numerous dendritic melanocytes (Fig. 1C).