TELEDERMATOLOGY READER REPORT1

History

Chief complaint

Presenting for diagnosis of a lesion.

History of present illness

A 56-year-old man presents with a "white spot" on the back that he states his new wife recently noticed. Prior treatment: none. His primary symptom: none. Prior biopsy: none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.

Image Quality Assessment

Fully satisfactory.

TELEDERMATOLOGY IMAGING READER REPORT

One image was provided that shows a circumscribed 7-cm oval pale patch with scalloped borders on a background of hyperpigmentation and telangiectasia on the left lower back. Inside the patch, there is a small 4-mm brown regular macule, and a small 3-mm raised papule is noted at the 10-o'clock position.

INTERPRETATION OF IMAGES

Lesion A

Findings

The presented lesion and history are most consistent with the diagnosis of a nevus anemicus. Notably, the hyperpigmentation and telangiectatic background suggest actinic changes consistent with poikiloderma and may have increased the noticeability of the lesion. The two lesions noted within the primary lesion are benign in their appearance and suggest a solar lentigo or normal melanocytic nevus (brown macule) and a nevus cell nevus (papule).

RECOMMENDATIONS

Skin Care and Treatment Recommendations

No treatment is indicated. If cosmetic treatment is desired, patient can be instructed to camouflage with concealer makeup.

RECOMMENDED FOLLOW-UP

Type of Visit

This lesion is benign; we recommend reassurance and follow-up as needed (pro re nata, PRN).

CLINICAL PEARL

Nevus anemicus usually presents as a hypopigmented patch in infancy or childhood; however, they may become more apparent with increased telangectasias because of actinic damage. It is a congenital vascular anomaly caused by localized hypersensitivity to catecholamies that result in vasoconstriction and pallor that is seen clinically (Davis, 2014). There is a lack of scale (which helps to differentiate it from tinea versicolor), and the major diagnosis in the differential is vitiligo. Intralesional injections of vasodilators such as bradykinin, acetylcholine, and histamine are not helpful in increasing blood flow and erythema to the nevus. More invasive procedures such as axillary sympathetic block and grafting have been shown to induce erythema at the site but are not indicated. This is a benign finding on physical examination and, for cosmesis, can be managed by noninvasive therapies such as concealers. That said, as with any dermatologic condition, if a lesion starts to grow, changes suddenly in appearance, or becomes symptomatic, that patient should be referred to dermatology for a face-to-face evaluation.

REFERENCE