Pigmented Lesion on Toe with New Black Dots - Dermatological Concern

Case at a Glance

A 28-year-old physically active male presents with concerns about changes in a pigmented lesion on his toe, specifically the appearance of new black dots adjacent to an existing mole over a two-week period.

Patient's Story

The patient, a 28-year-old male (6'0", 175 lbs) from New Jersey, noticed changes in a mole located on his toe. He had photographically documented the lesion on June 29th, at which time no black dots were visible. By July 14th, approximately two weeks later, he observed new small black dots appearing both next to the original mole and underneath his toe in an area without a pre-existing mole. The patient maintains an active lifestyle with regular walking and running, having completed two runs between the initial and follow-up photographs. He expressed concern about these new pigmented changes and their potential significance.

Initial Assessment

Patient presents with a pigmented lesion on the toe showing interval changes over a 2-week period. New satellite black dots have appeared both adjacent to the original mole and in previously uninvolved areas of the toe. Given the patient's active lifestyle involving frequent foot trauma from running, differential considerations include traumatic pigmentation versus concerning melanocytic changes.

The Diagnostic Journey

The patient demonstrated excellent self-monitoring by photographically documenting the lesion over time, clearly showing the evolution of new pigmented spots. The temporal relationship between increased physical activity (running) and appearance of new pigmentation raises questions about trauma-induced changes versus pathological progression. The patient appropriately sought dermatological evaluation given the concerning changes.

Final Diagnosis

Pending dermatological evaluation scheduled for the following Wednesday. Differential diagnosis includes traumatic subungual/digital hemorrhage, melanocytic nevus with satellite lesions, or early melanoma with satellite metastases.

Treatment Plan

Patient appropriately scheduled urgent dermatological consultation. Dermatoscopic examination and possible biopsy anticipated based on clinical findings. Patient advised to continue monitoring for further changes and avoid trauma to the area pending evaluation.

Outcome and Follow-up

Patient scheduled for dermatological evaluation within one week of symptom recognition. Outcome pending specialist assessment. Recommended continued photographic documentation and activity modification if advised by dermatologist.