28713 Dermoscopic changes observed in acute UV radiation

Abstract

A 55-year-old male with a history of melanoma of unknown primary which was metastatic to the right parietal scalp as well as metastatic squamous cell carcinoma status post radiation therapy, presented for surveillance exam. His wife was concerned about a changing spot on his back which was also his only concern at this visit. On exam he was severely sunburned. He stated that he had been at the lake all day a few days previously and had not reapplied any sunscreen. Examination of his back revealed a dark brown, irregularly pigmented papule with a reticular network and symmetric focus of irregular dark brown-purple blotches on dermoscopy. A shave removal was performed. Pathology demonstrated a compound melanocytic nevus with background changes compatible with recent sunburn. It was found that the brown-purple blotches observed on dermoscopy correlated with keratinocyte dyskeratosis and necrosis observed on histopathology. The patient was informed of these results and will continue to follow with routine surveillance. This case is important because it highlights an underreported but previously demonstrated fact that melanocytic nevi can have acute changes secondary to ultraviolet radiation which may be concerning for melanoma. Greater awareness in this area could allow more clinicians to reasonably follow patients with similar changes in nevi in the setting of an acute sunburn thus preventing unnecessary biopsies and decreasing patient anxiety by waiting for these biopsy reports.