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Abstract: This is a case of a 25-year-old male with a black patch on the skin surface of the right lateral buttock. It had been present since childhood, and no significant changes were seen over the years. He came to our hospital because of the suspicion of malignant melanoma after reviewing relevant information on the Internet. After surgical excision and pathological examination, he was diagnosed as a compound nevus based on the pathological examination results, and was cured after complete excision.
Basic information】Male, 25 years old
Type of disease】Composite nevus
Hospital】Harbin Hospital of Traditional Chinese Medicine
Consultation time】April 2022
Treatment plan] Extracutaneous surgery + pathological examination
Treatment Period】Outpatient surgery, followed by outpatient consultation after 7 days
Results】Complete excision of compound nevus, good wound recovery
I. Initial consultation
One day in mid-April, when it was raining in spring, a handsome young man of about 20 years old entered the clinic. The patient reported a black spot on his right buttock, which was not painful or itchy and had been there for a long time, saying that it had been there since he was a child. Although there was no obvious change, the patient was more worried that it was some kind of bad disease. On examination, a black mark of about 5 mm in diameter was found on the right lateral buttock with clear irregular edges and uneven color, which was mildly raised by hand touch, but there was no obvious pain on pressure and no redness or swelling around it. Based on the morphology of the skin surface alone, it was considered a compound nevus or intradermal nevus. After communicating with the patient and letting the patient understand the formation principle of nevus nigricans and the way to make a clear diagnosis, the patient agreed to undergo dermatopathological examination. According to the pathological results, the diagnosis of compound nevus was met.
II. Treatment process
To make a clear diagnosis of this kind of pigmented nevus on the surface of the skin, surgical excision and pathological examination are required. During the surgery, the patient is disinfected locally, and after the sterile wipes are laid, local lidocaine is used for infiltration anesthesia. 2-3 minutes of anesthesia produce the corresponding effect, and after the patient complains that the local pain disappears, the local black pigmented nevus is excised as a whole with a sharp knife. After the excision is completed, local pressure is applied to stop bleeding, and the skin is sutured with No. 4 silk thread. Then the skin was sterilely bandaged after local disinfection with iodophor solution. Patients were instructed to buy roxithromycin orally after going home to avoid infectious changes in the local wound. After complete excision, the pigmented nevus is cured and the result will be released after 7 days.
III. Treatment effect
The patient completely eliminated the black skin damage on the surface of the skin through surgical excision, and the patient was re-examined 7 days later at the outpatient clinic. After disinfecting the patient with iodophor, the wound was basically healed with mild crusting. According to the pathological results, the melanocytes at the dermal-epidermal junction of the patient’s skin tissue were nested, and the basal melanocytes of the damage were scattered singly, the damage was bilaterally symmetrical, but the dermis was visible asymmetrically up and down, and the melanocytes downward gradually shrank and had a shrunken appearance, and the dermal-epidermal, junctional cells, tidally round to ovoid, were approximately equally spaced from each other. No melanocytes were seen around the specimen dermis, showing that the diagnosis met the diagnostic criteria of compound nevus. It has been completely excised and clean.
IV. Notes
Through the treatment, the patient’s compound nevus has been excised cleanly, and it is glad to help the patient contact anxiety. Afterwards, if black pigmented nevus appears on the surface of the skin, it is not recommended for patients to stimulate themselves and avoid scratching or self-treatment to avoid the degeneration of the pigmented nevus after repeated stimulation, which may trigger the invasion of the pigmented nevus to the subcutaneous tissue and lead to the transformation to malignant melanoma, which is not good for health. After surgery, avoid getting water on the wound and contacting dirty things to avoid local tissue from breeding bacteria and causing changes in the nature of infection. Do not disassemble yourself while waiting for the removal of stitches at home to avoid poor healing of local tissues and wound dehiscence.
V. Personal insight
Pigmented nevus itself is also called mole cell nevus. It is a kind of change formed by pigment cells gathering on the same frame inside the skin, and is divided into epidermal nevus, composite nevus and intradermal nevus. The probability of malignant change of such compound nevus and intradermal nevus is relatively low, but the probability of malignant change of junctional nevus is relatively high. If a pigmented nevus appears in the skin without any abnormal sensation, painful ulceration, erosion, enlargement, crusting and other changes, it proves that the form of the pigmented nevus is relatively stable, so it can be temporarily observed and does not necessarily need immediate treatment. If the pigmented nevus shows enlargement, erosion, oozing, crusting, ulceration, bleeding and rapid color change within a short period of time, it is considered that malignant change may have occurred. In this case, it is necessary to go to the hospital for surgical removal and pathological examination in order to make a clear diagnosis, and usually the prognosis is good after removal, as in the case of patients.