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Pigmented Lesions

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Pigmented Lesions

What are pigmented skin lesions?

Pigmented skin lesions are black, brown or blue in color. They may be composed of melanocytes, or pigment-producing cells, of blood vessels, or of other types of pigment including reactive changes in the skin from trauma. Vascular lesions may appear black with the naked eye but can appear red, purple or blue under dermoscopy of the skin.

The color of pigmented skin lesions may be due to melanin, blood, or exogenous pigment.

What are the possible diagnoses for pigmented skin lesions?

Although most pigmented skin lesions are melanocytic, some non-melanocytic lesions can also be pigmented, particularly in dark-skinned individuals. There are 3 non-melanocytic lesion categories: keratinocytic, vascular, or reactive.

Melanocytic lesions

  • Melanoma – a type of cancer that develops from the pigment-containing cells known as melanocytes.
  • Benign melanocytic nevus – moles of various kinds including blue nevus.

Keratinocyte lesions

  • Seborrheic keratosis – a benign and common skin growth.
  • Lentigo- freckles of various kinds.
  • Epidermal nevus – an overgrowth of moles and lesions.
  • Pigmented basal cellcarcinoma (BCC) – a type of skin cancer.
  • Pigmented invasivesquamous cell carcinoma (SCC) – cancer cells that have spread to distant tissues.
  • Pigmented squamousintraepithelial neoplasia – lesions found in the vulva, penis, or anus.
  • Pigmented actinic keratosis – a scaly or crusted growth on the skin.

Vascular lesions

  • Trauma – such as a splinterhemorrhage in the nail.
  • Purpura -a rash from bruising or internal bleeding.
  • Cherry angioma – a collection of blood vessels.
  • Angiokeratoma – wart-like bumps that are red or black.
  • Angiosarcoma – a cancer of the inner lining of blood vessels.
  • Kaposi sarcoma – purple lesions made of cancer cells.

Reactive pigmentation

  • Dermatofibroma – a common benign fibrous skin lesion.
  • Post-inflammatory pigmentation – temporary pigment due to incidents such as burned skin.
  • Dermatofibrosarcoma protuberans – a rare tumor found in the skin.
  • Otherpigmented skin condition such as lichen planus (a skin rash that is triggered by the immune system).

Numerous other lesions and skin conditions are sometimes mistaken for a melanocytic or keratinocyte pigmented skin lesion.


For pigmented lesions that have turned precancerous or cancerous, therapy may include an excisional surgery to remove the lesion or Mohs surgery (a multi-step procedure used to treat advanced skin cancer).

For pigmented lesions that become bothersome or unsightly, such as birthmarks or “age spots”, laser and cosmetic treatments are possible options.

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