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JAMA Dermatology Clinicopathological Challenge
May 2015

Conflicting Dermoscopic Criteria in a Suspicious Lesion

Author Affiliations
  • 1Department of Dermatology, Stony Brook University Hospital, East Setauket, New York
  • 2Dermpath Diagnostics, Stony Brook University, East Setauket, New York
JAMA Dermatol. 2015;151(5):553-554. doi:10.1001/jamadermatol.2014.4633

A man in his 30s with no medical history of illness presented with a lesion of concern on his left scalp. The patient noted that the lesion had slowly enlarged over the preceding 5 years from when he first noticed it as a small bump. He denied a history of trauma prior to its development. The patient denied any spontaneous bleeding, crusting, or itching, and he was primarily concerned about its growth. There was no personal or family history of malignancy. On physical examination, the patient’s left frontal scalp revealed a mobile 1.2-cm mammillated, soft, brown plaque with protruding terminal hairs (Figure, A). The remainder of the patient’s skin examination revealed no other concerning lesions. There was no lymphadenopathy present. Dermoscopically, the lesion was characterized by irregular pigment globules, milialike cysts, and focal arborizing vessels (Figure, B). A shave biopsy was performed for histopathologic examination (Figure, C and D).

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