Clinical Challenge: Hyperpigmented Mole on Cheek - MPR

Clinical Challenge: Hyperpigmented Mole on Cheek

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A 48-year-old Hispanic woman presents to the clinic requesting removal of a mole on her right cheek. She states that the lesion has been present for years and has been gradually increasing in size and darkening in color but neither itches nor bleeds. Her family and personal histories are negative for skin cancer. Her mother has a similar appearing growth on her scalp. Upon physical examination, a sole 2.0cm hyperpigmented, firm nodule is observed; no similar lesions are noted elsewhere on the face or body.

Compound melanocytic nevi (CMN) are frequently encountered raised growths that are usually tan to brown in color. The pigmentation is most often homogeneous and distributed throughout the lesion. Lesions are round to oval in shape and are most often 2...

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Compound melanocytic nevi (CMN) are frequently encountered raised growths that are usually tan to brown in color. The pigmentation is most often homogeneous and distributed throughout the lesion. Lesions are round to oval in shape and are most often 2 mm to 6 mm in size, but can be larger.1,2

The surface of the nevus may be either smooth or papillomatous and the lesions generally appear in childhood or adolescence. In patients with lighter skin color, dermoscopy usually reveals a peripherally reticular pattern with central hypopigmentation. In persons with darker skin color, dermoscopy demonstrates central hyperpigmentation.3

Histopathology is characterized by nevus cells at the junction of the epidermal and dermal layers as well as within the dermis. Intradermal nevi, by contrast, are dome-shaped and skin-colored, and may be associated with terminal hairs. Nevus cells are confined to the dermis. CMN are benign and do not undergo malignant transformation.4

Few studies document the incidence of nevi in Hispanic populations, which is heterogeneous with skin types ranging from lighter to darker shades. Similar to White populations, a study found that for Hispanic patients, the number of acquired melanocytic nevi increases during adolescence and continues throughout a person’s life.5

References

  1. Oliveria SA, Yagerman SE, Jaimes N, et al. Clinical and dermoscopic characteristics of new naevi in adults: results from a cohort studyBr J Dermatol. 2013;169:848-853. doi:10.1111/bjd.12482
  2. Damsky WE, Bosenberg M. Melanocytic nevi and melanoma: unraveling a complex relationship. Oncogene. 2017;36(42):5771-5792. doi:10.1038/onc.2017.189
  3. Rogers T, Marino ML, Raciti P, et al. Biologically distinct subsets of neviG Ital Dermatol Venereol. 2016;151(4):365-384.
  4. Brodell R, Sims DM, Zaim MT. Natural history of melanocytic nevi. Am Fam Physician. 1988;38(5):93-101.
  5. Sosa-Seda IM, Valentín-Nogueras S, Figueroa LD, Sánchez JL, Mercado R. Clinical and dermoscopic patterns of melanocytic nevi in Hispanic adolescents: a descriptive studyInt J Dermatol. 2014;53(3):280-287. doi:10.1111/j.1365-4632.2012.5784.x