Benign, Dermatology, Malformation, Supernumerary Nipple, Teledermatology



  1. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, there is transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report. This is a case of a spot on the abdomen.


Article Content


Chief Complaint

Presenting for diagnosis.


History of Present Illness

A 54-year-old gentleman presents with a spot on his abdomen. The patient states that he is unsure how long the lesion has been present but that his new partner is concerned that it is an unusual mole and would like for him to have it removed. Prior treatment: none. His primary symptom: none. Prior biopsy: none.



Satisfactory. There are multiple lesions in the field. Identification of the lesion that is to be addressed by the consult; for example, marking by circling or placing an indication line would enhance diagnostic accuracy.



One image was provided noted as Problem A. The image shows a skin colored papule with a mammillated surface along the milk line. In addition, there are scattered bright red minute papules, noted hereafter as Problem B (see Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. Papule with mammillated surface along the "milk line" and scattered bright red minute papules on the abdomen.



Problem A

The morphology and distribution of the lesion along the "milk line" is most consistent with the diagnosis of a supernumerary (accessory) nipple.


Problem B

The bright red papules are consistent with cherry hemangiomas.




Both of these lesions are benign and do not need to be removed. Any changes to the lesions in size, morphology, or symptoms are indications for reevaluation.



Patient should return to primary care provider for reassurance and follow-up as needed.



Problem A

Supernumerary nipples are common congenital malformations, but a patient may not be aware of them or believe them to be a nevus (mole). Removal is not necessary. They are classically located along the embryonic milk lines but may also be ectopic. In humans, the "milk line" extends proximal to the axillary vault down the chest and abdomen and ends at the proximal inner thighs. They can be complete with breast tissue and ducts or be solely aberrant gland tissue (Nguyen, 2014). In addition, it is noteworthy to mention that supernumerary nipples do not appear to be associated with urinary tract malformation in apparently healthy individuals, despite earlier reports of such (Paller & Mancini, 2011).


Note that, if a patient wishes to pursue cosmetic removal, a small elliptical excision may be performed. Appropriate informed patient consent should be attained, and surgery should not be performed at spousal discretion, in a patient who has decision-making capacities and capabilities.


Problem B

Cherry hemangiomas are the most common benign cutaneous vascular lesions, which are formed by proliferations of dilated venules (Brown, 2014).




Brown C. W. (2014). Cherry hemangioma. Retrieved from[Context Link]


Nguyen N. V. (2014). Supernumerary nipple treatment and management. Retrieved from[Context Link]


Paller A., & Mancini A. J. (2011). Hurwitz clinical pediatric dermatology: A textbook of skin disorders of childhood and adolescence (4th ed., p. 28). New York, NY: Saunders/Elsevier. [Context Link]


Roman M., & Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal Dermatology Nurses Association, 6(6), 285-287.


11The standardized teledermatology reader report format is available for authors on the Journal's Web site ( and outlined in Table 1. [Context Link]