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Dr. Andrew Rynne

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What causes dark brown lesion on back?

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Dr. Johny Chacko

Dermatologist

Practicing since :2005

Answered : 1919 Questions

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Posted on Mon, 4 Aug 2014 in Skin Cancer
Question: Hello, Seeking a dermatologists opinion on a black lesion that has developed on my back. My 'wife' saw it a few months ago and it was dark brown but has turned to black when recently seen. It is firm, raised and not grown much in width, about 3mm Seems like there is a dark shadow under it though. Perhaps just a blackhead but I fear nodular melanoma ( having lost 2 family members to melanoma)
doctor
Answered by Dr. Johny Chacko 1 hour later
Brief Answer:
Please get a biopsy done

Detailed Answer:
Hello,

Welcome to healthcare magic.

I have gone through your history and have seen the clinical picture attached.

I would consider the possibility of a comedone or a blackhead. But I would also keep melanoma in the differentials because of its deep pigmentation and your positive family history.

I would have to palpate the lesion and see if the black portion can be " extracted" to confirm if it is a blackhead. Have you tried removing it ( like how they extract a blackhead) and has it come back?

I would advise you to get a skin biopsy by a dermatologist.

I do not want to make you more anxious, but looking at its appearance, melanoma has to be ruled out.

Hope this helps you.

Hope for the best,
Dr. Johny Chacko
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Johny Chacko 2 hours later
The lesion feels like a soft, small BB under the surface and could be opened pretty easy I believe but will wait until I see the dermatologist in 2 days ( the $18 was worth some peace of mind)
If it HAS grown it has been inward mostly and to my understanding a NM would grow quickly since March when 1st noticed ? Then again the color change is alarming. The family history was a maternal grandfather and a non blood relative.
I would be happy to share test results for your knowledge if you are interested.
Hopefully negative results with the very high mortality rate of NM... 90% within 30 months and 40% at 12 months was what I found ?
Thanks, XXXXXXX
doctor
Answered by Dr. Johny Chacko 15 minutes later
Brief Answer:
? Comedone/ ? Melanoma

Detailed Answer:
Hello Mr. XXXXXX,

I understand your concern about the lesion.

But I do hope you understand the limitations of an online consultation.

Let me tell you the points favoring the diagnosis of an " open comedone" or a blackhead-

1. Usually present on the back

2. The lesion appears in the picture as if it is like " stuck on" and can be removed by gently pressing downwards ( as how you get a blackhead out on the face). Since I cannot palpate, I am only telling this after closely looking at the picture.

3. Melanoma usually grows as a nodule or in case of a " superficial spreading" type, the black colour spreads outwards. Both of these features are absent in this lesion.

The mortality rate depends on the spread of lesions into the lymph nodes and also the type of lesion.

Do not worry. I know it is extremely stressful, but let us hope for the best.

Do let me know the progress if possible.

Regards,
Dr. Johny Chacko

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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