An example of a macroscopic picture of a meta- static nodule originating from adenocarcinoma of the pancreas. The figure presents a metastatic nodule as non- painful, brownish-pinkish, slightly firm, non-shifting within the skin, sized 2.0 cm in diameter, found on the back of a 61-year-old man 

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... is a useful, sufficient and widely used tool for examining pigmented and non-pigmented lesions [1, 2]. It may be helpful as a diagnostic method in the in- vestigation of non-characteristic skin nodules, occurring as solitary, pale or pinkish lesions, especially those of un- known origin or in the event of dealing with an unclear patient history. In the literature, there are only several case studies which have been published on the subject of dermoscopic images of metastatic nodules from internal malignancies [3–5]. Skin metastases occur in 0.6–10% of all patients with cancer and represent 2% of all skin tumors [6]. Among gastrointestinal tract malignancies, large intestine cancer among women and cancer of the esoph- agus, pancreas and stomach cancer among men can often metastasize to the skin [6]. Skin metastases from vis- ceral malignancies are important for dermatologists and oncologists because of their variable clinical appearance and presentation as well as frequent delay or even failure to diagnose them correctly [6]. Metastatic skin nodules occur as non-painful, single or multiple, hard or flexible, tiny, pinkish, small nodules, without any specific clinical diagnostic criteria [4]. Clinical diagnosis in such cases is not clear. From a histopathologic point of view, there are 4 main morphological patterns of cutaneous metastases involving the dermis, namely a nodular, diffuse, infiltrative and intravascular pattern [6]. In dermoscopic evaluation of non-pigmented skin nodules, vascular structures have often played a key diagnostic role, also in the diagnostic management of metastatic skin tumors [7, 8]. The authors report two clinically unspecific cases of dermoscopy, with the presence of a metastatic skin cancer derived from the gastrointestinal tract. Clinical examination with dermoscopy was performed in both of the cases presented below. Dermoscopic images from each lesion were obtained using a lens (Dermoscope Delta 20; Heine, Herrsching, Ger- many), mounted on a Nikon D 700 camera. Totally excised skin nodules were examined histopathologically with the use of a routine histopathological technique in hematoxylin-eosin staining (H + E). Histopathological specimens were sequentially examined field-by-field along the whole section length of the slide. This technique enables us to compare histopathological and dermoscopic pictures. This is the case of a 60-year-old woman diagnosed with stage IV pT N M sigmoid colon cancer. A tumor re- 3 1 1 section was performed and palliative chemotherapy un- dertaken between April and November 2010. Complete regression of metastases to the lung was thus achieved. Nine months later, she was found to have a recurrence of the cancer in her lung and ovary. After 6 courses of second-line chemotherapy, a small reddish nodule in the periumbilical area was observed. Clinical examination revealed a solitary, small, palpable, firm, painful nodule of 1.5 cm in diameter (Figure 1). Dermoscopic examination of the skin nodule manifested the presence of polymorphous vessels. Irregular, linear vessels were also observed in the area (linear straight and linear helical vessels) mimicking stellate telangiectasias as well as some dotted (red dots) and distributed peripherally (Figure 2). The vascular arrangement was irregular and chaotic. In all parts of the lesion, the background was whitish, confluent and homogenous. Partially small, roundish, yellowish dots were noted mimicking the yellowish hyperkeratotic plugs that were surrounded by a white halo. Because of the exacerbation of the pain caused by the skin lesion, the patient underwent a full surgical excision of the nodule. Histopathological examination of the skin tumor confirmed metastases from sigmoid colon cancer. A slight scaling with superficial subcorneal pustules with granulocytic debris were noted in the superficial part of the epidermis. A slight acanthotic proliferation of the epithelium was found. Proliferation has been observed in the superficial part of the dermis vessels. Also, well- visible multiple, metastatic carcinomatous emboli were found in the lumina of the curved and dilated, spirally elongated vessels. In the central part of the lesion, the neovascularization was the most pronounced (Figure 3). In the epidermis, proof was found for the presence of a dense, inflammatory infiltration, thickened and hyalin ized bundles of collagen and adenocarcinomatous tubules (Figure 4). The patient was directed to a third line of chemotherapy. A 61-year-old male patient was diagnosed with a tu- mor of the pancreas, abdominal lymphadenopathy and multiple liver tumors. The patient was not qualified for a biopsy of the tumors and was sent to an oncologist. Under clinical examination, further four skin tumors were found on his back. The nodules were non-painful, brownish-pinkish, slightly firm, non-shifting within the upper layer of the skin, sized up to 2.0 cm in diameter (Figure 5). A dermoscopy of the metastatic skin nodules showed the presence of a grouping of polymorphous, vaguely visible vessels mainly irregularly distributed, linear straight and linear serpentine in their form. After the application of slight pressure, the vessels rapidly vanished (Figure 6). The background of the nodules was whitish and structure less with several (4) brownish-gray, small roundish dots, irregular in shape and distributed peripherally. The largest tumor was excised and histopathologic examination proved metastatic adenocarcinoma originating from the pancreas. Based on dermoscopy conducted for histopathologic purposes, the final diagnosis of the type of pancreatic malignancy was performed and the patient was qualified for chemotherapy. In a histopathological examination in the superficial part of the dermis, pro liferating, curved, slightly dilated and elongated vessels with metastatic, carcinomatous emboli were observed. Interstitial fibrosis with hyalinization has also been indi cated (Figure 7). No secondary melanocytic colonization was found in this case. The results of our case studies described two dif- ferent dermoscopic images of metastatic skin nodules, which originated from cancer of the gastrointestinal tract. Dermoscopy revealed the presence of three predominant types of vascular structures. The first of these was an irregular, linear morphology. The second one was a dotted morphology (red dots), observed as multiple tiny red points, peripherally positioned next to each other. The third one took the form of both a linear straight and a linear serpentine. There is a relation between dermoscopic vascular structures and their histopathological features, seen as neovascularization with numerous curved, dilated vessels with inner metastatic emboli in both of the presented cases. All these vascular structures were distributed along with whitish, confluent, structureless de pigmentation. Histopathologically, it could correspond to fibrosis of the dermis with the hyalinization of bundles of collagen. In our experience, previously described cases of metastatic breast cancer were also characterized by the occurrence of polymorphous vessels located on a whitish background [4]. According to Zalaudek et al. [7, 8], the presence of linear irregular and dotted vessels, located centrally or irregularly, is commonly present in the case of thin or intermediate a melanocytic or hypomelanocytic melanoma. Also, the occurrence of regular, dotted vessels with positive additional dermoscopic criteria such as reticular depigmentation, chrysalis structures and depigmentation – all these may strongly suggest a melanocytic or hypomelanocytic melanoma or the Spitz nevus [7]. In differential diagnosis, mycosis fungoides lesions ex hibited a characteristic dermoscopic pattern consisting of fine, short linear vessels, and combined vascular struc tures composed of dotted and curved linear vessels occurring in patchy, orange-yellowish areas [9]. Arborizing vessels are a specific finding of the nodular cystic or the scleroderma-like basal cell carcinoma, or fine “microarborizing” vessels, with shiny red-white structureless areas, which are typical of the superficially spreading type of basal cell carcinoma [7, 8]. The feature which led to the exclusion of basal cell carcinoma (BCC) diagnosis was the absence of erosions [7, 8]. The pigmented brownish-grayish dots and globules resembling residuals of hyperpigmentation located peripherally, which were presented in our case study, were not characteristic of melanoma or pigmented variants of BCC [10, 11]. They were not similar to the previously described multiple blue or gray globules, leaf- like areas and spoke-wheel areas most commonly found in basal cell carcinoma [10, 11]. Dermoscopy of fibroepithelioma of Pinkus as a rare variant of BCC is also characterized by the occurrence of polymorphous vessels mainly consisting of fine, focused, short arborizing and dotted vessels, the latter mainly located peripherally, with visible short, white streaks [12]. Atypical, polymorphous vascular patterns with irregular linear-vessels, milky-red areas and globules can all be suggestive of a malignant process, also in the case of the Merkel cell carcinoma [13]. Perhaps it is possible that in the cases presented herein, the shape and type of the vessels depend on the stage of the nodule. Similarly to melanoma in its recent stages, dotted vessels are predominant [11]. Vessels characteristic of advanced tumors are wider, coarse, more irregular and variable [11]. To date, only dermoscopic features of metastatic melanoma have ever been widely described [14–17]. A clue for cutaneous melanoma metastases in differential diagnosis of bluish, purple or red nodules with recent onset may be found in the form of the presence of stellate telangiectasias surrounding the lesion [17]. In this case, linear, irregular prominent vessels or stellate telangiectasias at the periphery surrounded ...