A 58-year-old man presents for evaluation of a growth behind his left ear. The lesion has been present for at least 2 years and is occasionally irritated by hair combing; his barber urged him to have it removed. Past medical history is negative for skin cancer. Examination revealed a flesh-colored papule with a slightly erythematous base.
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A shave biopsy was performed, and histopathology revealed a dermal nevus. Acquired dermal nevi are raised lesions that commonly arise on the head, neck, and trunk.1 Two subtypes have been proposed—Unna nevus and Miescher nevus. Unna nevi are softer and located on the head, neck, and extremities, whereas Miescher nevi are dome-shaped and located primarily on the face.2 Both are well-circumscribed and range in hue from flesh colored to lighter shades of brown. Clinically, dermal nevi may resemble skin tags, and a majority are removed either for cosmetic reason or because elevation predisposes to trauma. Biopsy to rule out basal cell carcinoma may also be indicated. Shave excision usually provides acceptable results.3,4
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Winkelmann RK, Rocha G. The dermal nevus and statistics. An evaluation of 1,200 pigmented lesions. Arch Dermatol. 1962;86:310-315.
- Yus ES, del Cerro M, Simón RS, Herrera M, Rueda M. Unna’s and Miescher’s nevi: two different types of intradermal nevus: hypothesis concerning their histogenesis. Am J Dermatopathol. 2007;29:141-151.
- Ferrandiz L, Moreno-Ramirez D, Camacho FM. Shave excision of common acquired melanocytic nevi: cosmetic outcome, recurrences, and complications. Dermatol Surg. 2005;31(9 Pt 1):1112-1115.
- Bong JL, Perkins W. Shave excision of benign facial melanocytic naevi: a patient’s satisfaction survey. Dermatol Surg. 2003;29:227-229.