Photo Rounds

Dark mole on face

A 19-year-old woman presented to her family physician (FP) with a dark mole on her face. She said that the mole had been there for more than 5 years, but indicated that it had been getting darker. She was worried that it might be skin cancer and wanted it removed. The physician noted a 4-mm darkly pigmented, slightly raised lesion. The patient denied any personal or family history of skin cancer.

What’s your diagnosis?


The physician suspected that this was a benign blue nevus because it had a regular border and was uniformly dark in color. He also recognized that melanoma is very rare at age 19. That said, it is hard to ignore a changing mole that is so black in color.

The patient wanted it removed, so a 5-mm punch biopsy was performed. (See the Watch and Learn video on punch biopsy.)

When the punch core was removed, the physician noted that the pigment was visible in the deep dermis (as expected with a blue nevus). A single suture was placed, and the patient was scheduled for follow-up in one week. The pathology report came back as a blue nevus, which is completely benign.

While many blue nevi actually appear blue because of the Tyndall effect causing the dark melanin in the deep dermis to create a blue coloration, some will appear black (as was seen in this case). On the follow-up visit, the suture was removed and the incision was healing well. The patient was reassured that this was a benign mole and was happy with the cosmetic result.

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.

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