Suggest treatment for severe acne

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Posted on Wed, 15 Mar 2017 in Skin Hair and Nails
Question: I have a question regarding what I believe is a pimple. Two years ago, I had a severely atypical mole removed from my neck. They labeled it as an atypical nevus but with borderline qualities that made them think it was close to melanoma (only a small part of it, Most of the mole was fine). I had two different pathologists look at it and both concluded the same thing (one labeled it "severely atypical" while the other said "Moderate to severe but some minimal pagetoid spread put it in the borderline category."). I had a wide excision three weeks later with clear margins. Since then, I keep getting what I think are pimples inside this scar. I don't just get pimples there, but on that side of my neck in a variety of areas. I'm wondering if this is a concern, to have a pimple in this scar continually reappear. This one has been there for about ten days or two weeks but seems to be getting smaller - or at least not larger. If this was something like nodular melanoma, would it never get smaller? My dermatologist believes it is just hormonal acne that happens to appear inside the scar and near it; like I said, that area of my neck seems very acne prone, but this pimple in particular keeps leaving only to reappear.
doctor
Answered by Dr. Kakkar S. 1 hour later
Brief Answer:
Need a better Image and more information

Detailed Answer:
Hello. Thank you for writing to us

I am dr.kakkar (dermatologist). I have gone through your query and I have noted your concern.
I have viewed the Images. I am sorry but the Images are not very clear. I request you to kindly upload a clear/ focused Image.
This could just be a hypertrophic scar since it is right inside the scar Or a foreign body granuloma (secondary to hair keratin). It is unusual that a pimple would form within the scar because a scar usually lacks sebaceous glands or hair follicle.
Does this pimple ever pop?or does it always feels like nodule which never pops?Does it itch?
Though a nodular melanoma can be amelanotic but more often than not it is darker in color. So, it does'nt seem like a nodular melanoma.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kakkar S. 2 hours later
I have attached some more images that I think are a bit clearer. Please note the image titled "image 6" includes another "pimple" for comparison. The bump in question definitely feels like a pimple - I feel as though I could pop it. I have had these inside my scar before and they go away within a week or so, like other acne. It doesn't itch at all. One went away when I put toothpaste on it, which often works for my acne. If it was a nodular melanoma, would it ever go away or would it just continue to grow? I know some melanomas regress, but I assume that takes quite a while to happen. Thank you!
doctor
Answered by Dr. Kakkar S. 11 hours later
Brief Answer:
The lesions are acneform and not melanomas

Detailed Answer:
Hi. Thank you.

The images definitely seem like some of these lesions also have a pus head, so they definitely are acneform. The one near the scar is a similar lesion too though it is probably arising from the skin immediately adjacent to the scar.
None of these seem like a nodular melanoma. As I said, a nodular melanoma is usually darker, rarely it is skin colored/ amelanotic. Moreover it is highly unlikely that a nodular melanoma would self resolve. Nodular melanoma is usually aggresive and would continue to grow.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 11 hours later
Thank you. Yes I think it is a pimple as well. But in general regards to Nodular melanoma, what kind of things should I look for? Do they resemble dark sores that don't heal? Do nodular melanomas ever resemble pimples? And is their growth visible to the naked eye? What I mean by this is I know that they grow inwards, which is why they're so dangerous, but does the outer lesion change too?
doctor
Answered by Dr. Kakkar S. 6 hours later
Brief Answer:
Regarding nodular melanoma

Detailed Answer:
Hi.

A nodular melanoma may arise either from a pre- existing nevus or from clinically normal skin. More often it is pigmented and rarely it may be amelanotic. Though a pimple is amelanotic but distinction is easy because a pimple resoles within a few days. A melanoma rarely resolves. It usually keeps growing.
A darker lesion which looks different from other 'signature moles' (the ugly duckling sign) Or a nevus which has recently changed in terms of size, color, symmetry or has ulcerated or bled is suspicious of a melanoma. This rule holds true for any melanoma including a nodular melanoma.
A recent change in these parameters is what comes to the notice of most patients and is visible to the naked eye.
A nodular melanoma commonly arises on head and face which are sun exposed sites, is typically raised from the begining (i.e has a radial growth component) as compared to other signature moles or a superficial spreading melanoma which are flat or minimally raised. A nodular melanoma may also ulcerate ans bleed. Since a noduar melanoma grows vertically (therefore becomes raised) so it comes to the patients notice early as compared to a superficial spreading melanoma which grows horzontally initially.
A nodular melanoma has a deeper component from the begining as compared to superficial spreading melanoma which is why they are dangerous and may spread to distant sites. A growing nodular melanoma would definitely be different (the ugly duckling) as compared to a other signature benign raised nevus in terms of vareigated color, size, symmetry and ulceration or bleeding and most inportantly, a RECENT CHANGE in appearance!!

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8903 Questions

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