Scarring in Benign Skin Lesions: A Normal Finding
Yes, scar-like changes in the skin are completely normal for certain benign lesions, particularly lymphomatoid papulosis (LYP), which characteristically leaves scars and hyperpigmentation after spontaneous regression of individual lesions. 1
Benign Lesions That Commonly Produce Scarring
Lymphomatoid Papulosis (LYP)
- Scars and hyperpigmentation are residual changes that occur after spontaneous regression of papulonodular lesions in LYP, which is a benign CD30-positive lymphoproliferative disorder 1
- Each individual tumor lesion spontaneously regresses within weeks or months, leaving behind these characteristic scar-like changes 1
- This scarring pattern is so typical that it serves as a clinical diagnostic feature of the condition 1
Other Benign Lesions With Tissue Changes
- Dermatofibromas are benign lesions that involve fibrotic tissue changes in the dermis and may have a firm, scar-like texture on palpation 2
- Seborrheic keratoses can have varied surface textures including rough, warty, or stuck-on appearances, though they don't typically produce true scarring 2, 3
When Scar-Like Appearance Should Raise Concern
Melanoma Considerations
- True local scar recurrence after melanoma excision represents a distinct clinical entity that requires re-evaluation and potential re-excision 1
- Regression in melanoma (a malignant process) can create scar-like tissue, which is documented as a histopathological parameter in melanoma assessment 1
- Any pigmented lesion with recent change (evolution) in size, color, or shape requires excision, not observation 1
Clinical Pitfalls to Avoid
- Do not assume all scar-like skin changes are benign without proper evaluation - obtain a complete history about whether the lesion has changed, bled, or appeared recently 1
- If diagnostic uncertainty exists based on history and gross examination, biopsy for histopathologic examination is mandatory to rule out malignancy 2
- For any suspicious pigmented lesion, complete excision with a 2 mm margin is preferred over partial biopsy to allow full histological assessment 1, 4
- Never use laser or electrocautery for initial removal of diagnostically uncertain lesions, as tissue destruction compromises pathological diagnosis 1
Practical Approach
- Document whether the scar-like appearance is from a known regressed lesion (as in LYP) versus a new finding 1
- Examine for the ABCDE criteria in any pigmented lesion: Asymmetry, irregular Borders, heterogeneous Color, large Diameter, and Evolution 1
- Regular assessment of all skin lesions during patient consultations increases diagnostic accuracy and helps identify potentially problematic lesions 5