Concerning Pigmented Lesion in Pregnant Patient
Case at a Glance
A 28-year-old pregnant woman at 36 weeks gestation presented with concerns about a newly noticed pigmented lesion on her shoulder with irregular coloration pattern.
Patient's Story
The patient discovered a mole on her shoulder while performing a self-examination of her skin due to acne in the area. She described the lesion as having an unusual appearance with a dark, star-shaped central portion surrounded by a flesh-colored raised area. The patient reported having multiple moles throughout her body but had not been monitoring this particular lesion due to its location in a hard-to-see area. She was unable to determine if the lesion had recently changed in size. Her current medications included occasional cetirizine hydrochloride 10mg for allergies.
Initial Assessment
Physical examination revealed a pigmented lesion on the shoulder with asymmetric coloration - a dark central portion in an irregular star-like pattern surrounded by a flesh-colored raised border. The lesion appeared symmetrical in overall shape but demonstrated concerning color variation. Additional erythematous papules consistent with acne were noted in the surrounding area.
The Diagnostic Journey
Given the patient's pregnancy status and the atypical appearance of the lesion, particularly the irregular pigmentation pattern, dermatological consultation was recommended. The differential diagnosis included atypical nevus, melanoma, or other pigmented skin lesions. Dermoscopic examination was indicated to better characterize the lesion's features.
Final Diagnosis
Atypical pigmented lesion requiring dermatological evaluation with dermoscopy for definitive diagnosis
Treatment Plan
Urgent dermatological referral for comprehensive skin examination including dermoscopic evaluation of the concerning lesion. Full-body skin examination recommended given the patient's multiple nevi. Biopsy consideration pending dermatological assessment, with special attention to pregnancy-safe procedures if intervention is required.
Outcome and Follow-up
Patient counseled on the importance of dermatological evaluation while reassured that immediate panic was not warranted. Scheduled for dermatology consultation with recommendation for ongoing skin surveillance, particularly important given pregnancy-related hormonal changes that can affect pigmented lesions.