Could This Patch of Open Comedones Prompt Further Evaluation?

Introduction. A 44-year-old woman with a past medical history of left congenital cataract and migraines presented to a dermatology clinic with an intermittently draining lesion on the left upper chest that had been present for as long as she could remember.

History. The patient initially presented to the dermatology clinic for evaluation of skin changes on the left upper chest. Upon physical examination, there was a 3x3 cm patch of black keratin plugs arranged in a honeycomb pattern with a firm hyperpigmented 5 mm subcutaneous nodule to the inferior aspect. (Figure 1) Upon further questioning, she reported that the chest lesion had been present for “as long as she could remember” with occasional drainage of the black plugs and self-limited intermittent tenderness and swelling of the subcutaneous nodule.

Fig. 1. Untreated nevus comedonicus on the chest of a 44-year-old woman.