Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Melanoma
• Atypical nevus
• Acrochordon (skin tag)
• Neurofibroma
• Dermatofibroma
• Blue nevus – typically macular, 2-5 mm, and with a blue hue
• Combined nevus – two types of nevi that are seen together in one lesion; most commonly blue nevus and dermal or compound nevus
• Recurrent melanocytic nevus – history of the initial biopsy is often critical for the dermatologist and/or pathologist. Recurrent nevi characteristically occur in women, 20-30 years of age, on the trunk within 6 months of the original biopsy. While many different clinical morphologies may be seen, it often manifests as a scar with variegated hyper- or hypopigmentation, linear streaking and halo, stippled and/or diffuse pigmentation patterns. While most cases do not pose a diagnostic challenge on histopathology, some specimens, especially partial biopsies, may look indistinguishable from melanoma on histopathologic grounds alone.
• Desmoplastic nevus – typically small (< 1 cm) skin-colored to erythematous to mildly pigmented papule or nodule on the extremity of a young adult (average 30 years of age). Histopathology reveals spindled to epithelioid melanocytes within a fibrotic stroma.
• Pigmented basal cell carcinoma
• Wart

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References

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