TELEDERMATOLOGY READER REPORT1
History
Chief complaint: presenting for diagnosis of a lesion.
History of present illness: a 26-year-old gentleman presents with a "brown spot with hair" (primary lesion) on his trunk (location) that he believes he noticed in high school (~10 years ago, duration). Prior treatment: none. His primary symptom: this lesion is asymptomatic. Prior biopsy: none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.
Image Quality Assessment (Evaluation of Image Quality by Teledermatology Provider)
Fully satisfactory.
[Evaluator picks one: Fully satisfactory/marginal satisfactory with suggestions for improvement/unsatisfactory]
Teledermatology Imaging Reader Report
One image was provided that shows a diffuse asymmetric tan-to-brown patch with overlying hypertrichosis (terminal hairs, coarser than the surrounding body hair) involving the central and left chest (Figure 1).
Interpretation of Images
Lesion A
Findings. The presented lesion and history of peripubertal presentation is consistent with the diagnosis of a Becker's melanosis (Becker's nevus).
RECOMMENDATIONS
Skin care and treatment recommendations
We recommend reassurance of the benign nature of this lesion to the patient. Per patient preference, cosmetic treatment options include electrolysis, waxing, excision and grafting, and laser-assisted hair removal.
RECOMMENDED FOLLOW-UP
Type of visit
Return to primary provider for reassurance and for discussion of cosmetic options, if patient would like to pursue treatment.
[Type of visit: completing teledermatology provider picks one: return to primary provider for treatment/refer to dermatology clinic for evaluation (face to face)/lesion is benign, recommend reassurance and follow-up as needed pro re nata (PRN).
CLINICAL PEARL
The pathogenesis of Becker's nevus is unknown; however, androgens are thought to play a role, given the male predominance, peripubertal development, hypertrichosis, and occasional development of associated acneiform papules within the lesions. Becker's nevus is believed to be a benign process. It may be associated with smooth muscle hamartoma, hypoplasia of underlying structures, ipsilateral limb shortening, localized lipoatrophy, and accessory scrotum (Rivers, 2014).
REFERENCE