Photo Rounds

Dark patch on leg

A young woman presented to her family physician (FP) with a dark patch on her lower leg. She indicated that she’d had this from early childhood and wanted to know if something could be done about it. She wasn’t sure what it was and said she was often self-conscious when wearing shorts.

What’s your diagnosis?


The FP recognized this to be a nevus spilus (speckled nevus).

He explained that this was a benign nevus and that no treatment was indicated—especially because the only effective treatment would be deep excision down to the subcutaneous fat layer (requiring a graft for closure). The patient probably wouldn’t like the cosmetic result and the risks of this surgery (pain, infection, graft not taking) are not acceptable for this condition. Also, the procedure would not be covered by insurance, as this would be considered cosmetic surgery.

The physician explained that in the unlikely event of significant changes in the nevus, she should seek further evaluation. The patient understood the reality of the situation and thanked the doctor for explaining the diagnosis to her. She was reassured that this was benign.

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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