A Growing Pigmented Lesion in a Child With a History of Bone Marrow Transplant and Irradiation
A 14-year-old Hispanic female with a history of aplastic anemia requiring 2 bone marrow transplants presented with a 4-month history of a 6-mm brown-black papule in her left lower abdomen (Figure 1). The lesion occasionally bled but was not associated with pruritus or pain. Her oncologic history was significant for chemotherapeutic conditioning accompanying her first transplant (age 8 years) and 12 Gy of total body irradiation with the second transplant (age 10 years). There was no personal or family history of skin cancer. On dermoscopy, a central brown ulceration was surrounded by leaflike structures, spoke-wheel areas of radial projections, and shiny white areas. Nonspecific blue-white structures were also noted (Figure 2). Physical examination did not reveal any other suspect skin lesions or lymphadenopathy. An excisional biopsy was performed and submitted for dermatopathologic review (Figure 3).
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Ashish Bhatia, MD, Web Editor, Archives of Dermatology.