Simple cases

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Case 42

15-year-old girl with a few brown spots on her nose

For a few years, and I am getting more.

The age of patient makes a lentigo senilis/solaris impossible.

No, they stay the same.

With this simple question, you have excluded an ephelis or freckle, and made possible the correct diagnosis. Freckles darken with sun exposure and fade over the winter.

Yes, on her face and hands.

Careful—the mother may have something entirely different, such as lentigo senilis/solaris

Yes, that's why we're here, because my grandmother just had a melanoma on her leg cut off.

Always a good question, but doesn't help here.

Yes, our family sails a lot and I got burned once in a while.

Good question, but these spots are not sun-related.


Good question for melasma, a diffuse facial pigmentation in women, which is hormone-sensitive.

Choose the right efflorescences:

Atrophy means a loss of substance to the skin; here the skin looks and feels normal.

Lichenification is caused by persistent rubbing of the skin and features exaggerated skin markings.

These flat circumscribed dark spots are macules.

Choose the right diagnosis:

Good. Small pigmented lesions, sometimes present at birth, with increased melanin and sometimes small number of excess melanocytes.

Close but wrong. Café-au-lait macules are larger and more tan ; they are most uncommon on the face.

Vitiligo features white spots where the skin has lost all its melanocytes. Just the opposite process.

Most melanocytic nevi are palpable, as they have accumulations of melanocytes in the dermis or epidermis. Some feel a lentigo simplex could represent a very early junctional nevus in some cases.

Choose the right therapy(ies):

Since there is no risk of malignant change, destruction without histologic examination is acceptable, if the lesions are cosmetically bothersome. Hypopigmentation is a common complication of this treatment.

Correct! No treatment is needed.

The scar would be worse than the little macule.

Probably the treatment of choice—quicker and cheaper than a laser and produces comparable results.

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