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The blue nevus is an uncommon lesion that may appear worrisome due to its similar appearance to the sinister melanosarcoma. The blue nevus is a subset of dendritic melanocytic proliferations that is commonly believed to be remnant embryonal neural crest cells that failed to migrate from the dermis.
This is a case of a 58 year old male who presented with a bluish lump on his right third finger for 6 months complaining of dull ache, swelling, and decreased range of motion (ROM). The impression of the lesion was of a blue nevus, a benign tumor that required investigation and follow up due to concern for a melanoma. His pain and decreased ROM can be attributed to repeated use due to his trade and were later deemed as red herring presentations.
Although histopathology continues to be the good standard in the diagnosis and classification of melanocytic nevi lesions, ultrasound can be considered as a quick tool to characterize and quantify such lesions as a preliminary exam to rule out more concerning features of melanomas.
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