A pigmented lesion with yellow-white globular-like structures-Answer.

Below is the answer to the quiz by Dr. Rishpon presented in the previous issue of Dermatology Practical & Conceptual [2015;5(1):13].

Answer

Balloon cell nevus

Discussion

Balloon cell changes in a nevus correspond to nests of vacuolated melanocytes, caused by enlargement and disintegration of melanosomes [1]. Dermoscopic correlation has been reported as white or yellow globules [2-4]. These globules were confirmed to correlate with junctional and dermal melanocytic nests seen on reflectance confocal microscopy, similar in size and location to the balloon cell nests in histology [2]. It is important to differentiate the white/yellow globules from other structures similar in color and shape, including milia-like cysts and sebaceous glands [3].

This case highlights how clinical and dermoscopic primary morphology serves as a direct correlate of unique histologic features.

Congratulations to Dr. Akhilesh Shukla (drakhilesh89@gmail.com), who was the first to send us the correct answer!