Evaluation and Management of a Congenital Melanotic Nevus in a 38-Year-Old Female Patient
A clinical case involving a 38-year-old white female with a large, multi-lobular, localized melanotic growth on her neck is presented. This growth, present since birth, is currently inflamed and sensitive to touch, causing discomfort only recently. Despite its history, the patient has not sought medical attention before but wishes to explore removal options. Key differential diagnoses include papilloma and congenital melanotic nevus, potentially complicated by ingrown hairs. Although generally not harmful, monitoring for changes is advised, with referral to a dermatologist considered for management.
Evaluation and Management of a Congenital Melanotic Nevus in a 38-Year-Old Female Patient
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Presentation Transcript
Jonah Foutz 536-7-12 Team 1 Clinical Competency
The Patient • 38 year old, white female • No medications • Current tobacco use • No significant hospitalizations • No allergies
The Case • Large, multi-lobular, localized, sensitive, inflamed, melanotic growth on the back of the neck. • Sensitive to touch at the moment. • Usually asymptomatic • Has had since birth • Approximately 4 cm in diameter
Patient dialogue • How long have you had this? • Since I was born • How long has it been hurting? • About a week • Has it hurt before in the past? • Yes, occasionally it will get inflamed. • Has it changed in size, shape, or color over time? • Yes it has gotten larger, but hasn’t changed shape or color. • Have you ever been to a physician about this? • No, but I do want to get it removed.
Differential Diagnosis • Papilloma • Congenital melanotic nevus with ingrown hair that is causing inflammation and pain. • Melanoma
Congenital melanotic nevus with ingrown hair. Treatment- Refer to dermatologist. Other comments- Not harmful so not necessary to remove unless patient desire. May want to due to the many times it gets inflamed from ingrown hairs. Also told to keep an eye on the size, shape and color because these have been known to develop into melanoma in a small percent of cases. Provisional Diagnosis and Treatment
Congenital Melanotic Nevus • Congenital nevi are present at birth and result from a proliferation of benign melanocytes in the dermis, epidermis, or both. The actual etiology is unclear, but congenital nevi are found on 1-2 % of newborns and range in size from small nevi (<1.5 cm), medium nevi (1.5-19.9 cm), and large nevi (>20 cm). The larger the nevi, the greater the chance of developing into a melanoma.
