A 45-year-old woman comes to the physician for a periodic health examination. She has a pigmented lesion on her right leg that she first noticed a few years ago and would like to have checked. The patient does not think that the mole has changed in appearance. She has had some sunburn in the past.
The patient is fair skinned and has reddish-blond hair and hazel eyes. Skin examination shows multiple cherry angiomata over her trunk and some on her upper extremities. There is dense freckling over her shoulders and barely perceptible dense freckling over her cheeks. There is a homogenous, well-demarcated, circular, light brown, and nonelevated lesion 5 mm in diameter over her right distal tibial area. No border irregularity is seen under dermoscopy.
Which of the following is the best next step in management of this patient?

Question

A 45-year-old woman comes to the physician for a periodic health examination.  She has a pigmented lesion on her right leg that she first noticed a few years ago and would like to have checked.  The patient does not think that the mole has changed in appearance.  She has had some sunburn in the past.
The patient is fair skinned and has reddish-blond hair and hazel eyes.  Skin examination shows multiple cherry angiomata over her trunk and some on her upper extremities.  There is dense freckling over her shoulders and barely perceptible dense freckling over her cheeks.  There is a homogenous, well-demarcated, circular, light brown, and nonelevated lesion 5 mm in diameter over her right distal tibial area.  No border irregularity is seen under dermoscopy.
Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

This patient's presentation is consistent with melanocytic nevi, common benign pigmented lesions found on the skin of most individuals. The coloration can be variable, ranging from tan to jet black. They tend to be < 6 mm in diameter and have a symmetrical and homogeneous surface with sharp borders. Nevi usually concentrate in sun-exposed areas. Suspicious nevus should be examined for the following clinical features of melanoma as the early superficial form can closely resemble nevi. melanocytic nevi < Asymmetry (if a lesion is bisected, one half is not identical to the other)Border irregularitiesColor variation (brown, red, black or blue/gray, and white)Diameter > 6 mmEvolving: lesion changing in size, shape, or color; new lesion Asymmetry (if a lesion is bisected, one half is not identical to the other) Border irregularities Color variation (brown, red, black or blue/gray, and white) Diameter > 6 mm Evolving: lesion changing in size, shape, or color; new lesion Lesions with a greater number of these criteria have a higher chance of being a melanoma. Melanomas are further classified as superficial spreading, lentigo maligna, acral lentiginous, and nodular. superficial spreading lentigo maligna acral lentiginous Lesions suspicious for malignancy should have excisional biopsy with a 1 to 2 mm rim of normal-appearing skin (Choice A, B, & D). The clinician should also examine other areas (eg, scalp, palms and soles, between the toes) for possible lesions. Once the diagnosis of melanocytic nevi has been established, these lesions require no treatment other than periodic observation. Most nevi remain benign throughout the patient's life and do not require prophylactic removal. Patients should receive periodic skin examinations and use adequate sun protection. (Choice E) Topical fluorouracil is used in both actinic keratosis and superficial basal cell carcinoma. Educational objective: Melanocytic nevi are benign pigmented lesions that are usually tan to jet black in color, tend to be < 6 mm in diameter, and present with a symmetric and homogeneous surface with sharp borders. Melanoma should be ruled out in all pigmented lesions. Melanocytic nevi usually require no treatment other than periodic observation as most remain benign. < __________ References: Biopsy for malignant melanoma-are we following the guidelines? (http://www.ncbi.nlm.nih.gov/pubmed/18492398) Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. (http://www.ncbi.nlm.nih.gov/pubmed/15585738) Systematic skin cancer screening in Northern Germany. (http://www.ncbi.nlm.nih.gov/pubmed/22074699)

A 45-Year-Old Woman Comes to the Physician for a Periodic