Does the phrase “pigmented lesion” mean something to you? Or does is it sound strangely foreign? The online Merriam-Webster dictionary defines lesion as, “1. Injury, harm. 2. an abnormal change in structure of an organ orpart due to injury or disease; especially: one that is circumscribed and well defined.” So in the skin, a lesion is an area that presents with a change from the surrounding normal skin. Pigmented lesions account for a large proportion of referrals from primary care physicians. Many patients also self-refer after noticing a funny looking pigmented spot on their skin. The majority of these referred pigmented lesions do not turn out to be melanoma, but I still believe in better safe than sorry. Dermatologists are trained to distinguish a concerning pigmented lesion from a benign (safe) spot. We do this by looking at the spot and we might use a special lens to look at the spot (dermoscopy). If we’re concerned enough about the spot, we may biopsy it (cut out a small piece of it) or cut it out all together and send the skin to a pathologist. The pathologist is a doctor who looks at the cells of the tissue and tells us what the lesion is.
Pigmented lesions can be many things. Of course, we’re most concerned about catching a melanoma, which is a serious type of skin cancer that can spread to other parts of the body and cause all sorts of problems including death. Then there are atypical moles, which we call “dysplastic nevi.” We believe that some percentage of these can turn into melanomas. That’s why if the pathologist tells us that your mole is atypical with a certain degree of atypia (usually moderate atypia or worse), then we may suggest that you get your mole cut out. Keep in mind though that melanomas don’t have to evolve from moles. They can arise from a part of your skin that never had a mole before! This type of melanoma is said to arise de novo. A pigmented lesion can also be many other things. Again, better safe than sorry. When in doubt, find someone who is trained to distinguish the good, the bad, and the ugly pigmented lesions.