Child Has a Black Mark Against Him
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Joe R. Monroe, MPAS, PA, practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Physician Assistants.

A lesion has been growing on this 4-year-old boy’s hand since birth. Is his family right to worry about cancer?

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Child Has a Black Mark Against Him

A 4-year-old boy is referred to dermatology for evaluation of a lesion on his left hand. It has been present since the child’s birth, growing very slowly as he does. The lesion is asymptomatic, and the patient is otherwise quite healthy. Unfortunately, a relative had suggested that the lesion could “turn into cancer” if not removed promptly. The child’s parents asked the pediatrician for his opinion—and although he had few if any concerns, he decided to make the referral.

The boy is calm during the examination. There is a 1.7×1.0-cm black nevoid macule on the dorsal aspect of his left hand. The lesion’s margins and color are even and uniform. Its surface has uninterrupted normal-appearing skin lines, with no induration or other surface disturbance on palpation.

No nodes or other masses are detected on palpation of the epitrochlear and axillary areas.

Which of the following statements about this lesion is incorrect?

It has very little chance of malignant transformation.

There are no good reasons to consider removal.

It will grow considerably larger as the child grows.

It is a congenital melanocytic nevus.

Clinician Reviews. 2019 September;29(9):3e

This quiz is not accredited for CME.

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