This 24-year-old woman presents to dermatology for evaluation of excessive scarring on her chest. It developed slowly in a spot from which a cyst was surgically removed more than two years ago. In addition to being unsightly, the lesion is sometimes symptomatic: It often tingles and feels “tight.” Worst of all, it still seems to be growing.
She has never experienced anything like this—not even following her C-section several years ago. There is no family history of similar problems. The patient says she tans easily, holds a tan well, and rarely burns in the sun.
The lesion is clearly cicatricial, quite firm, and slightly pink. It has rounded edges and an exceptionally smooth surface. Located on the left sternal chest wall, the lesion has obliterated any sign of the original surgical scar, except for peripheral scars left by the sutures. The patient’s skin type is a strong IV/VI.
What is the diagnosis?