Case #13 Discussion

Summary:

Localized pigmented surface lesion

Lesions to Exclude from the Differential Diagnosis:

Intravascular lesions

  ~Blanch upon pressure

Extravasated blood lesions

  ~Red, blue or purple (not brown)

  ~Resolve or begin to resolve in less than 6 weeks

  ~Do not become progressively darker

Tattoo

  ~The patient would have reported trauma if it had occurred on the lip

  ~Color – these are gray to black, not brown

Oral Melanotic Macule

  ~Occurs on non-exposed mucosal surfaces

  ~Does not darken when exposed to sunlight.

Nevus and melanoma

  ~Usually thickened

  ~Do not darken when exposed to sun

Lesions to Include in the Differential Diagnosis:

Ephelis (Freckle)

  ~Non-thickened, non-tender, does not blanch

  ~Color – Brown

  ~Darkens when exposed to sunlight

Management:

Patient education: It is a freckle, it will get darker with sun exposure, and no treatment is needed.  Routine follow-up is recommended.  Discuss with the patient the value of using sunscreen to prevent sun damage and skin cancer formation.

Final Diagnosis:

Ephelis (Freckle)