DERMOSCOPY CASE OF THE MONTH

Pigmentation in a scar: Use of dermoscopy in the

management decision
Elvira Moscarella, MD,a Giuseppe Argenziano, MD,a Aimilios Lallas, MD,a Caterina Longo, MD,a
Samer Al Jalbout, MD,b and Iris Zalaudek, MDa,c
Reggio Emilia and Modena, Italy; and Graz, Austria

CLINICAL PRESENTATION
In case 1, a small focal area of pigmentation occurred adjacent to the scar of a previously excised
superficial spreading melanoma in situ that had been removed 1 year earlier (Fig 1, A; arrow). Case 2
presented with star-like pigmentation that occurred 4 months after an incomplete shave biopsy
specimen of a dermal nevus (Fig 2, A). In case 3, there was band-like pigmentation extending
perpendicular to the main axis of a scar of a compound nevus that was excised a few months earlier
(Fig 3, A).

DERMOSCOPIC APPEARANCE
Dermoscopic examination of the first lesion revealed structureless pigmentation extending beyond
the edge of the scar into the normal skin (Fig 1, B). Fig 2, B shows irregular globules, irregular streaks,
and structureless brown-gray areas confined to the scar extending radially from the center to the
periphery. Thin, brownish lines perpendicular to the scar are seen in Fig 3, B.

HISTOLOGIC DIAGNOSIS
The histologic examination revealed recurrent melanoma (case 1), a recurrent nevus (case 2), and
reactive pigmentation (case 3).

Fig 1. Recurrent melanoma. A, Clinical image of the scar of a superficial spreading melanoma in situ, excised one year
before, on the shoulder of a 50-year-old woman. A small focal area of pigmentation (arrow) is slightly visible adjacent to the
scar. B, Dermoscopy showing a structureless brown pigmentation extending beyond the scar into normal skin.

From the Skin Cancer Unit,a Arcispedale Santa Maria Nuova, IRCCS,
Reggio Emilia, and the Departments of Dermatology at the
University of Modena and Reggio Emilia,b Modena, Italy, and
the Medical University of Graz,c Graz, Austria.
Supported in part by the Italian Ministry of Health (RF-2010-
2316524).
Conflicts of interest: None declared.
Reprint requests: Elvira Moscarella, MD, Skin Cancer Unit,
Arcispedale Santa Maria Nuova, IRCCS, Viale Risorgimento 80,
42100 Reggio Emilia, Italy. E-mail: elvira.moscarella@gmail.com.
J Am Acad Dermatol 2013;69:e115-6.
0190-9622/$36.00
ª 2013 by the American Academy of Dermatology, Inc.
http://dx.doi.org/10.1016/j.jaad.2013.03.008

e115
e116 Moscarella et al J AM ACAD DERMATOL
SEPTEMBER 2013

Fig 2. Recurrent nevus. A, A star-like, brown pigmentation detected clinically 4 months after a
shave biopsy of a dermal nevus located on the back of a 35-year-old woman. B, Dermoscopy
shows irregular globules, irregular streaks, and structureless brown-gray areas, extending
within the scar radially from the center to the periphery.

Fig 3. Melanotic pigmentation. A, Band-like, brownish pigmentation extending perpendicular

to the main axis of a scar of a compound nevus excised a few months earlier located on the
back of a 40-year-old man. B, Dermoscopy showing thin, brownish lines extending perpen-
dicular to the scar.

KEY MESSAGE
The differential diagnosis of newly developing pigmentation within a scar includes recurrent
nevus, recurrent melanoma, and melanotic reactive pigmentation. A relatively rapid develop-
ment of the repigmentation favors the diagnosis of a benign recurrence. This is confined within
the scar and, dermoscopically, a regularly pigmented network and thin parallel streaks are
associated with reactive pigmentations, whereas an irregular prominent network, globules,
streaks, and heterogeneous pigmentation are usually associated with a melanocytic prolifer-
ation.1 Melanomas tend to recur months if not years after excision at the edges of the scar in the
normal skin.2 Dermoscopy may not reveal specific melanoma features, displaying only a
heterogeneous, structureless pigmentation. Therefore, in the case of a recurrent pigmentation
involving the normal skin around the scar, a biopsy specimen should be obtained to exclude a
possible melanoma recurrence.

REFERENCES
1. Botella-Estrada R, Nagore E, Sopena J, Cremades A, Alfaro A, Sanmartın O, et al. Clinical, dermoscopy and histological
correlation study of melanotic pigmentations in excision scars of melanocytic tumours. Br J Dermatol 2006;154:478-84.
2. Longo C, Moscarella E, Pepe P, Cesinaro AM, Casari A, Manfredini M, et al. Confocal microscopy of recurrent naevi and recurrent
melanomas: a retrospective morphological study. Br J Dermatol 2011;165:61-8.