Evolving Blue Nevus on Scalp with Recent Changes

Case at a Glance

A 29-year-old female presents with a longstanding blue nevus on her scalp that has recently undergone changes in size, elevation, and symptoms, raising concerns about malignant transformation.

Patient's Story

The patient reports having a small, flat blue nevus on her scalp since childhood. Over the past several months, she noticed the lesion had grown larger and become raised. She experienced occasional itching at the site and reported one episode of bleeding. Her current medications include apixaban for anticoagulation, sertraline for depression, and propranolol for hypertension or anxiety management. Concerned about the recent changes, she sought medical evaluation.

Initial Assessment

Physical examination revealed a blue-pigmented lesion on the scalp that appeared raised compared to its previously flat appearance. The patient's description of recent growth, elevation, pruritus, and bleeding episode warranted further dermatological evaluation. Given her anticoagulant therapy with apixaban, the bleeding episode required careful consideration of both medication effects and lesion characteristics.

The Diagnostic Journey

Initial clinical assessment suggested the lesion was likely benign based on visual appearance. However, the recent morphological changes and symptoms necessitated dermatoscopic examination to rule out malignant transformation. The patient was advised that comprehensive skin examination would be needed to assess for the 'ugly duckling sign' and to evaluate the lesion in context of her overall skin pattern.

Final Diagnosis

Pending dermatoscopic evaluation of blue nevus with recent morphological changes. Differential diagnosis includes benign blue nevus versus potential malignant transformation.

Treatment Plan

The patient was scheduled for dermatoscopic examination using specialized equipment for detailed lesion analysis. The evaluation would help determine if the lesion remains benign or requires biopsy for histopathological examination. Patient education was provided regarding warning signs of melanoma and the importance of regular skin surveillance.

Outcome and Follow-up

Patient scheduled for dermatoscopic examination. Further management decisions regarding biopsy or monitoring to be determined based on dermatoscopic findings. Long-term follow-up planned for surveillance of this and other pigmented lesions.