Dr. Pablo Umbert
Pablo Umbert, Director of the Pablo Umbert Dermatology Service at the Clínica Corachan in Barcelona, Corresponding Member of the Real Academy of Medicine of Catalonia, Honorary Member of the Catalan Society of Dermatology, and Full Member of the Royal European Academy of Doctors (READ), published on 10 June in the Salud & Vida section of the digital edition of “La Vanguardia” the article “Facial Pigmentations Mimicking Malignancy,” in which he addresses the importance of determining the origin and significance of the different spots or pigmentations that appear on the face in order to rule out malignancy.
“The face, unlike other skin surfaces, is a slippery terrain in dermatology. It concentrates pilosebaceous follicles, melanocytes (responsible for pigmentation), capillaries, and actinic damage. This combination favors pigmentation that may challenge diagnosis, prognosis, and treatment, and even simulate malignant lesions. Therefore, the clinical image alone is not always sufficient. In some cases, a dermatoscope with polarized light (epiluminescence) is required to visualize previously invisible structures. In addition, the history of the lesion must be consistent with the most probable diagnosis. When there are reasonable doubts, a biopsy is required (with results available within days), or, in some centers, the DIC procedure (immediate cutaneous diagnosis) allows for diagnosis within minutes. In rare cases, processing of the biopsied tissue with immunohistochemical techniques is necessary to identify specific tumor cell marker proteins,” the expert explains.
The academic briefly reviews the most common conditions, including pigmented seborrheic keratoses, common from middle age onward; post-inflammatory hyperpigmentation, benign reactions without risk following eczema, burns, or insect bites; solar lentigo, frequent in adults with a history of sun exposure; lentigo maligna, which occurs in older individuals and carries a risk of malignancy; melanoma, characterized by rapid evolution and malignant potential; and pigmented actinic keratoses, premalignant lesions resulting from sun damage.
The expert advises remaining calm and avoiding alarm when any skin sign appears, while maintaining appropriate follow-up. He recalls that clearly benign clinical lesions do not require treatment unless for aesthetic reasons. “The key lies in balancing prudence and precision—medical history, dermoscopy, and, when in doubt, biopsy or DIC. Photoprotection and follow-up, especially in at-risk individuals, are essential,” Umbert concludes.
