I was reviewing the September 2015 issue [Dermatologic Look-Alikes, “Enlarging brown spots“]. Immediately, I noticed a pinkish spot on the right medial clavicular region, which potentially could be a lichenoid keratosis, an actinic keratosis, a superficial basal cell carcinoma, a squamous cell carcinoma in situ, or the one diagnosis nobody wants to miss and is probably more unlikely, a melanotic melanoma. The point of why I am writing is that the “enlarging brown spot” most definitely appears to be a solar lentigo. I’m not sure if the pinkish lesion was treated, discussed, or potentially overlooked.

If the lesion was not addressed, the patient should return to have it re-evaluated to have it possibly treated or biopsied.—JUAN KOJIMA, PA-C, San Diego, Calif. (207-3)

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.