Growing Red Papule on a 13-Year-Old's Face: Should We Worry?

Introduction. A 13-year-old boy presented to the dermatologist with an irregular growth located on the right zygoma that had been present for at least 3 years. 

History. The patient’s family reported that the lesion had been growing over time. No prior treatments had been attempted, and no factors seemed to improve or worsen it. The patient has no family history of melanoma. His medical history includes asthma and eczema as a baby. Current medications include loratadine 5 mg daily and albuterol sulfate as needed for asthma management. This patient is up to date on all childhood vaccinations. 

Physical examination. The patient appeared well-nourished, well-developed, alert, oriented, and in no acute distress. On further inspection, we observed a 0.8 cm pink, dome-shaped papule with irregular borders on the right central zygoma (Figure 1). The remainder of the physical examination was unremarkable.

Figure 1. A 0.8 cm pink, dome-shaped papule with irregular borders on the right central zygoma

Diagnostic testing. Based on the patient's presentation, the differential diagnosis included hemangioma, melanoma, pyogenic granuloma, and Spitz nevus. Given the lesion’s growth, patient concerns, and clinical suspicion of malignancy, we decided to excise the lesion with 0.1 cm margins and send it for pathological evaluation. We discussed the risks of scarring, prolonged wound healing, and wound care with the patient, who tolerated the procedure well. The pathology report revealed well-defined clusters of epithelioid melanocytes, with a junctional component at the basal layer and nest formation extending into the dermis.