Differential Diagnosis
- Single most likely diagnosis
- Benign nevus with changes due to skin irritation or trauma: The patient's history of a mole inside the belly button for 13 years with recent changes, such as spreading out and development of darker spots that come off when picked, could be indicative of a benign nevus that has undergone changes due to skin irritation or trauma. The absence of bleeding, itching, or infection also supports this diagnosis.
- Other Likely diagnoses
- Seborrheic keratosis: The description of darker spots that tend to come off when picked could be consistent with seborrheic keratosis, a common benign skin growth.
- Dermatosis papulosa nigra: This condition is characterized by small, dark spots that can appear on the skin, often in areas with high sun exposure, and can be similar to the description provided.
- Keloid or hypertrophic scarring: The changes in the mole could be due to scarring from previous trauma or irritation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant melanoma: Although the patient's history and symptoms are not highly suggestive of melanoma, it is crucial to consider this diagnosis due to its potential severity and the fact that melanoma can present with varied symptoms.
- Lymphoma: The presence of palpable lymph nodes on the left side of the armpit and elbow, although likely reactive or due to another benign cause, necessitates consideration of lymphoma, especially given the patient's extreme health anxiety, which may lead to increased vigilance and detection of lymphadenopathy.
- Rare diagnoses
- Neurofibromatosis: The presence of a long-standing mole with recent changes and the development of new darker spots could, in rare cases, be associated with neurofibromatosis, especially if there are other systemic symptoms or family history.
- Congenital melanocytic nevus: Although less likely given the patient's age and the description of the mole, a congenital melanocytic nevus could undergo changes over time and potentially give rise to new, darker spots.