Dermoscopic decoding of a pedunculated scalp nevus: A visual guide

A 24-year-old woman presented with a symptomatic, gradually progressive, solitary, and skin-colored growth on her scalp for the past 5 years. This was a pedunculated skin-colored to brownish, soft, verrucous growth of size 4 × 4 cm over the right parietal region [Figure 1a]. Differential diagnosis of nevus sebaceous, trichilemmoma, seborrheic keratosis, non-pigmented basal cell carcinoma, and squamous cell carcinoma were considered. Dermoscopy revealed a polychromatic (white, brown-yellow, and red), homogenous, smooth papillomatous pattern with brownish structureless areas, brownish dots and globules, brown streaks, dilated linear to serpiginous vessels, lacking any pigment network, or atypical vascularity [Figure 1b]. The lesion was excised and sent for histopathological examination, which reported dermal nests and cords of nevus cells along with dermal melanin in typical maturation patterns. Moderate perivascular chronic inflammatory infiltrate with increased fibroblasts was also seen [Figure 1c]. These findings correlate well with dermoscopic observations and are consistent with an intradermal nevus.

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Figure 1

(a): Clinical image of a solitary, pedunculated, skin-colored, brownish, soft, verrucous growth (4 × 4 cm) over the right parietal region of the scalp; (b): Dermoscopy revealing a polychromatic (white, brownish-yellow, and red) homogenous (blue, green asterisk), smooth papillomatous pattern with brownish dots and globules (red asterisk), brown streaks (red asterisk), dilated linear to serpiginous vessels (red arrows) [DermLite 4, polarized, contact mode, 10x]; (c): Photomicrograph depicting dermal nests and cords of nevus cells along with dermal melanin in their typical maturation pattern (zonation) from superficial epithelioid forms (Type A cells) to smaller lymphocytoid forms (Type B and C cells) in deeper dermis. Perivascular chronic inflammatory infiltrate with increased fibroblasts is also seen in the reticular dermis (Hematoxylin and eosin, 40x).

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This case highlights the dermoscopic characterization of an intradermal nevus over the scalp, guiding differential diagnoses and emphasizing the crucial role of histopathology for definitive confirmation and appropriate management.