Photo Rounds

Mole on forehead

A 35-year-old woman went to see her family physician (FP) because she was concerned about a growing mole on her forehead. She said she’d had this mole since childhood, but over the past year, it had become more raised. She denied a personal or family history of skin cancer, but was worried that it could be a skin cancer because of its growth.

What’s your diagnosis?


 

The FP recognized this as a probable intradermal nevus. (Even benign nevi can grow in early adulthood and not be malignant.)

The features that suggested that this was a benign intradermal nevus included that it was a raised symmetrical papule on the face without suspicious signs of melanoma. Intradermal nevi are frequently skin colored because the melanocytes are deep in the dermis. The nevi may show small amounts of color, but are not likely to be dark, as might be seen in a compound nevus or melanoma. The differential diagnosis for a slightly pearly lesion like this, with small visible blood vessels, includes a nodular basal cell carcinoma.

The patient wanted to have the nevus removed to ease her anxiety and because she didn’t like the way it looked. While many insurance companies would reject payment for a cosmetic procedure, they are unlikely to reject payment with a diagnosis of a changing nevus.

The FP reviewed the risks and benefits of a shave biopsy with the patient. A shave biopsy with a sterile razor blade was performed after anesthetizing the area with 1% lidocaine and epinephrine by injection. (See the Watch and Learn video on shave biopsy.) Hemostasis was easily achieved with aluminum chloride in water.

At the 2-week follow-up, the biopsy site was healing well and the patient was reassured that it was only a benign intradermal nevus.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M, Usatine R. Benign nevi. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:945-952.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.

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