Case of a Slowly Growing Pigmented Lesion on the Leg of a 28-Year-Old Male

Case at a Glance

A healthy 28-year-old male presented with concerns about a pigmented lesion on his leg that has been present for over three years and has shown slow growth. A remote assessment suggested a benign nature but emphasized the need for an in-person clinical evaluation for a definitive diagnosis.

Patient's Story

The patient is a 28-year-old male, 6'3" and 215 lbs, with no known medical issues. He takes no medications and is a non-smoker. He presented for an opinion on a skin lesion on his leg, which he first noticed over three years ago. The patient reports that the lesion has been growing very slowly over this period but has become more noticeable to him recently. His primary concern was whether the lesion could be cancerous and if he should seek an urgent medical appointment.

Initial Assessment

The initial consultation was conducted remotely based on a patient-provided photograph. The image showed a pigmented lesion on the skin of the leg. The patient's history indicated a long-standing lesion with recent, slow enlargement. He reported no associated symptoms such as itching, pain, or bleeding. The primary concern was the potential for malignancy, specifically melanoma, given the history of change.

The Diagnostic Journey

A physician reviewed the patient's photograph and history. The initial impression from the image was that the lesion was likely benign. However, the physician highlighted the limitations of a remote diagnosis from a non-dermatoscopic, consumer-grade photograph. It was noted that a crucial component of skin cancer screening, the evaluation for an "ugly duckling sign" (a mole that looks unlike others on the body), could not be performed without a full-body skin examination. The lack of high-resolution or magnified views prevented a detailed assessment of the lesion's structure.

Final Diagnosis

A definitive diagnosis was not made. The lesion was provisionally assessed as a likely benign nevus. A final diagnosis is pending an in-person dermatological examination, including dermatoscopy, and a potential skin biopsy if deemed necessary.

Treatment Plan

The recommendation was for the patient to schedule a routine (non-urgent) appointment with a dermatologist or their primary care physician. The plan includes a comprehensive in-person evaluation of the lesion and a full-body skin check. Further management, such as continued observation or excisional biopsy, would be determined based on the clinical and dermatoscopic findings from that visit.

Outcome and Follow-up

The patient was advised to seek care for a definitive assessment. He was counseled that while the lesion did not appear immediately concerning from the single photograph, any new changes (e.g., rapid growth, color change, bleeding) should prompt a more urgent evaluation. The outcome is contingent on the findings of the future clinical consultation.