Recurrent Pigmentation Following Repeated Shave Biopsies of Dysplastic Nevus

Case at a Glance

A 32-year-old woman with a family history of melanoma presented with concerns about pigment recurrence following two shave biopsies of a dysplastic nevus with mild atypia.

Patient's Story

The patient, a 32-year-old female weighing 120 lbs with no current medications, has a significant dermatologic history including one mild and one severely graded dysplastic nevus. Her family history is notable for melanoma in her paternal aunt. She initially presented with concerns about a pigmented lesion that was subsequently biopsied.

Initial Assessment

In 2021, the patient underwent a shave biopsy of a concerning mole. The histopathological examination revealed a lentiginous compound melanocytic nevus with dysplasia-type mild atypia. Importantly, the lesion was not present at the histologic margins, indicating complete excision.

The Diagnostic Journey

Following the initial biopsy, the patient noticed pigment recurrence in the biopsy site, described as a few brown specks that were less extensive than the original lesion. Due to her anxiety and family history, she requested re-evaluation in 2022. A second shave biopsy was performed at her request, which again demonstrated clear margins with no residual dysplastic tissue.

Final Diagnosis

Recurrent benign melanocytic proliferation following complete excision of dysplastic nevus with mild atypia. The pigment recurrence represents residual deep melanocytes rather than dysplastic tissue.

Treatment Plan

The patient continues regular dermatologic surveillance every 6 months. No further surgical intervention was recommended given the benign nature of the recurrent pigmentation and clear histologic margins on both biopsies.

Outcome and Follow-up

The dermatology team reassured the patient that pigment recurrence after shave biopsy is not uncommon, particularly with deeper melanocytic nevi. The consulting dermatologist noted that the second procedure may not have been necessary and advised against further biopsies unless there are significant clinical changes. The patient continues routine skin surveillance without current concerns from the medical team.