Dermoscopy of cutaneous metastasis of colorectal adenocarcinoma in a patient with phototype V

V; peppering-like pigment.A 52-year-old man presented with a 4-month history of pink pruritic papules in the pubic area.He was undergoing treatment for stage IIIB colorectal adenocarcinoma, diagnosed 2 years earlier.On physical examination, he had skin phototype V and showed pink papules coalescing into an indurated, hyperpigmented plaque on his abdomen, scrotum, and right leg (Figs 1 and 2, A).He also had lymphedema of the legs, penis, and scrotum.Dermoscopy revealed globular structures with a saccular pattern, associated with bright white septa and brown borders, on a structureless white background with peppering-like pigmentation.The lesions were surrounded by pale pink globular areas, giving them an erythematous appearance.Scattered punctate vascular structures, short linear vessels, and irregular linear vessels were also identified (Figs 2 and 3, A, B).Histopathological examination showed lymphatic invasion and infiltration of malignant glandular epithelial cells in the desmoplastic dermis, with morphology similar to the primary colorectal tumor (Fig 3), confirming the diagnosis of cutaneous metastasis.Cutaneous metastases from colorectal carcinomas (CMCCs) are rare. 1 Dermatoscopic reports of CMCC in light-skinned patients describe the main dermatoscopic findings as a polymorphic vascular pattern and a white, pinkish, or reddish background without defined structures.2-6 Since vascular patterns are more difficult to observe in dermoscopy of high-phototype patients, the description of new structures in these individuals could lead to earlier diagnoses and improved prognosis. 2 Our patient presented saccular structures with bright white septa and peppering-like pigmentation, adding new CMCC findings.This case highlighted the need for further dermatoscopic documentation in patients with skin of color.The correlation of dermatoscopy structures is described in Table I. 2,7,8