ABSTRACT
Early amelanotic melanoma is characterized by uniformly arranged dotted vessels over a pink background. In intermediate and thick melanoma, a polymorphous vascular pattern, consisting of dotted and linear vessels, is most commonly seen. Truly amelanotic melanoma is rare, comprising about 2%–8% of all melanoma subtypes. In contrast and by definition, truly amelanotic melanoma lacks any pigmentation. Amelanotic melanoma is a great masquerader that can mimic a range of skin lesions including inflammatory skin lesions and also benign tumors such as hemangioma, pyogenic granuloma, and lichen planus–like keratosis or intradermal nevus that are not routinely excised. Management rules to avoid missing amelanotic melanoma include confirming the diagnosis of a lichen planus-like keratosis6 or pyogenic granuloma always by histopathology. In contrast to melanoma in situ, early invasive amelanotic melanoma typically exhibits a combination of dotted and small coiled vessels.
