From the Guidelines
A half inch by quarter inch raised, darkened lesion on the scalp with symmetrical borders and 2-3 darker spots within the lesion is concerning for a potential melanocytic lesion, and given the asymmetry is not explicitly mentioned, it is crucial to prioritize further evaluation to rule out melanoma. The presence of darker spots within the lesion may indicate color heterogeneity, which is one of the characteristics of suspicious lesions as outlined in the 'ABCD rule' 1.
Key Considerations
- The lesion's symmetry suggests benign characteristics, but the internal darker spots warrant further investigation 1.
- Dermoscopic evaluation by an experienced physician can enhance diagnostic accuracy and provide additional information regarding vascular patterns and pigment network distribution 1.
- A full-thickness excisional biopsy with a minimal side margin is recommended for diagnosis, and processing by an experienced pathology institute is mandatory 1.
Recommendations
- Excisional biopsy is recommended to rule out dysplastic changes or early melanoma, given the potential for melanocytic lesions to exhibit variable presentations.
- Regular monitoring for changes in size, shape, color, or symptoms is advised, with repeat biopsy indicated if growth or irregular features develop.
- The histology report should follow the American Joint Committee on Cancer (AJCC) classification and include relevant information such as maximum thickness, mitotic rate, presence of ulceration, and clearance of surgical margins 1.
Further Evaluation
- Mutation testing for treatable mutations may be considered in patients with advanced disease or high-risk resected disease, but is not recommended for primary tumors without metastases 1.
- The lesion's characteristics, including its size, shape, and color, should be carefully documented for baseline comparison during follow-up examinations.
From the Research
Clinical Description of the Lesion
- The lesion is described as a half inch by quarter inch raised, darkened lesion on the scalp.
- It appears symmetrical and contains 2-3 darker spots within the lesion.
Dermoscopic Features
- The presence of darker spots within the lesion may be indicative of melanocytic features, such as globules or dots, which are commonly seen in melanomas 2, 3.
- The symmetry of the lesion may be suggestive of a benign tumor, such as seborrheic keratosis; however, some melanomas can also present with symmetrical features 4, 2.
- The darkened color of the lesion may be indicative of a melanocytic lesion, and the presence of multiple darker spots within the lesion may suggest a more complex lesion 5, 3.
Diagnostic Considerations
- The clinical and dermoscopic features of the lesion may be suggestive of a melanoma that resembles seborrheic keratosis, which can be a diagnostic challenge 4, 2, 3, 6.
- Dermoscopy can improve the diagnostic accuracy of melanomas that clinically resemble seborrheic keratosis, and the use of dermoscopic features such as the blue-black sign, pigment network, and pseudopods or streaks can aid in the diagnosis of these lesions 3, 6.
- A biopsy with histologic examination may be necessary to confirm the diagnosis of the lesion, especially if the dermoscopic features are unclear or suggestive of a melanoma 5, 2.