Pre-emptive diagnosis of a case of scabies by dermatopathology

Abstract

A 39-year-old woman reported to her general practitio-ner with a new pigmented skin lesion on her right pectoral region. Dermatoscopically there were no suspicious features and the decision was made to monitor it over a three-month period. At follow-up imaging there was some minor change, possibly related to technical factors (the original camera/dermatoscope combination was not available), and after dis-cussion with the patient a decision was made to perform an excisional biopsy. The pathologist reported the lesion as a: “… dysplastic naevus of the compound type” with “… mild atypia and active lymphocytic regression.” He made the addi-tional comment: “Two apparent scabies mites are present.” This was not expected, as the patient had complained of no symptoms of scabies and no skin eruption had been observed to suggest that diagnosis.The patient returned for her routine postoperative review one week after the excision. She now complained of an intensely itchy skin eruption and wondered if she was having an allergic reaction to the local anaesthetic or antiseptic skin preparation solution used at the time of surgery. Examination