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July 6, 2012 / molehunter

Traumatised wart by bra strap

A common story presented to the doctor is of a skin lesion which recently has itched, bled and changed colour and size. This is a story that merits attention as these can be danger signs. However, very often the reality is of a seborrhoiec keratosis, or wart, which has become traumatised, perhaps by a clothing strap or scratching. The dermoscope can be helpful at sorting out these potentially alarming but harmless lesions.

This lesion comes with a history of itching, bleeding and recent change.

Dermoscopy shows looped/hairpin vessels in halos as a global feature of the lesion, strongly suggestive of a seborrhoiec keratosis or wart. We also see some blood within the lesion pointing to recent trauma. At about 10 o’clock we see some charcoal flecks suggesting thrombosed capillaries. There are no features of a basal cell cancer or a melanocytic lesion. It is safe to measure (ideally photograph) and review in 2 weeks, if annoying it could be removed by shave excision and light cautery and sent for histology. It would also be OK to freeze it, but if you do, it would be prudent to take and store a photo. Obviously if in doubt always refer, but the dermoscopic features here point clearly to a traumatised papilloma (i.e. wart) and not to anything else.
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