Differential Diagnosis
- Single most likely diagnosis
- Benign nevus: The mole has been present for over 13 years, was previously evaluated by a dermatologist 6 years ago and deemed benign, and lacks characteristics concerning for malignancy such as bleeding, itching, or a recent change in appearance. The soft and spongy texture is also more suggestive of a benign lesion.
- Other Likely diagnoses
- Seborrheic keratosis: A common benign skin growth that can be soft and have a varied appearance, which might fit the description of the mole.
- Dermatofibroma: A benign skin lesion that can feel soft or spongy and is often found on the arms or legs but can appear elsewhere, including near the belly button.
- Anxiety disorder: Given the severe health anxiety, it's possible that the patient's symptoms are exacerbated or primarily driven by psychological factors rather than an underlying physical condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant melanoma: Despite the mole's long-standing presence and previous benign evaluation, any mole, especially one that prompts concern, should be evaluated for the possibility of melanoma, given its potential for severe consequences if missed.
- Lymphoma: The presence of palpable lymph nodes in the elbow and neck could indicate a lymphoproliferative disorder. Although less likely, given the context, it is crucial not to miss such a diagnosis.
- Other cancers (e.g., breast cancer, gastrointestinal cancers): These could potentially explain the lymphadenopathy and IBS symptoms, although they are less directly related to the mole itself.
- Rare diagnoses
- Neurofibroma: A type of soft tissue tumor that can feel soft and spongy, associated with neurofibromatosis type 1, though this would typically be part of a larger syndrome with other diagnostic features.
- Metastatic cancer to the skin: Extremely rare and would typically be associated with a known primary cancer, but could potentially present with a skin lesion and lymphadenopathy.