Suspicious dark mole on brown skin
A middle aged man with type 4/5 skin presented with a new, solitary pigmented lesion on the upper back.
Definite ugly duckling. NB this lesion has been biopsied from the top left. To have excised the whole lesion on the upper trunk of a person with richly pigmented skin would risk a bad keloid scar. Here is a the dermoscopy.
We see chaos, blue white veil and deeply pigmented clods. It was initially suspected to be a pigmented BCC, which is sometimes seen in darker skin. The shiny white area is reaction, probably early scarring after the biopsy. However, an experienced dermatologist thought it might be an unusual presentation of an inflammatory condition such as lupus, sarcoidosis or even TB.
Skin cancer is uncommon, but not unknown, in Asian skin.
The histology showed lichen planus. This is a very unusual presentation, firstly as this condition usually presents as a more widespread rash, and secondly because of the deep pigmentation. If this was a white person, I would be highly suspicious of melanoma. However, it was inflammatory
The moral of this case is that richly pigmented skin behaves differently, with hyper- or hypopigmentation common as a result of inflammation. That is a story for another day.