Annals of Plastic Surgery

Issue: Volume 47(3), September 2001, pp 349-350

Publication Type: [Letters]

ISSN: 0148-7043

Accession: 00000637-200109000-00027

[Letters]

Can a Tick Mimic a Pigmented Skin Lesion or Melanoma?

Akbas, Hayati MD*; Hokelek, Murat MD, PhD+; Guneren, Ethem MD*; Eroglu, Lutfi

MD*; Demir, Ahmet MD*; Eroglu, Cafer MD++; Uysal, O. Ata MD*

Author Information

*Department of Plastic and Reconstructive Surgery

+Department of Microbiology and Clinical Microbiology

++Department of Clinical Microbiology and Infectious Diseases

Ondokuz Mayis University Medical School

Kurupelit, 55139

Samsun, Turkey

Address correspondence to Dr Akbas.

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Outline

References

Pigmented skin lesions are common lesions. Some of them are malignant and the

others are benign. It is very important to make the correct diagnosis before

treatment. Early diagnosis and treatment are needed to obtain a cure for

malignant pigmented skin lesions. 1 We present a case that was similar to some

pigmented lesions clinically and needed to be differentiated from this type of

lesion. We could not find a similar report in the literature.

Ticks are arthropods belonging to the class Arachnida, and are important vectors

for the transmission of rickettsial, viral, and bacterial diseases. The tick

obtains its blood meal by embedding its head in the skin-a process that usually

produces no symptoms. If the tick goes unnoticed, it may remain attached to the

skin, engorging itself with its host's blood for days at a time. Hard ticks

generally exude a liquid cement from the salivary glands that hardens and holds

the mouth parts in place for the 7 to 14 days required for blood meals. The

saliva contains local anesthetics, so the bite is painless, and contains a

substance that prevents coagulation of the victim's blood. 2

A 43-year-old patient was referred to us for biopsy of a pigmented skin lesion

on his abdomen. Clinical examination revealed a 4 x 3 x 2-mm pigmented lesion

with a dark-black color. There were no border irregularities, ulceration,

bleeding, satellite lesions, or other findings, but there was hyperemia just

around the lesion (Fig). The lesion itched mildly. It was noticed approximately

2 weeks earlier and had enlarged. We observed and palpated this lesion with

care, and we decided that it did not look like a real skin tumor, and surmised

that it may be an insect. We then removed this interesting mass with special

care, using alcohol in the region, and examined the lesion with a microscope.

The diagnosis of a tick was made. In retrospect, the patient had gone to a

picnic 2 weeks earlier, which was possibly the source of this arthropod.

Before treating pigmented skin lesions, it is essential to know certain clinical

factors, particularly the age of the patient, the history and anatomic location

of the lesion, and previous surgery or trauma to the area in question. The age

is important because some malignant pigmented skin lesions are common with

increasing age and are extremely rare in children, and some occur predominantly

in children and young adults and are increasingly uncommon in the elderly. 3

A number of pigmented lesions are difficult to classify, and raise the

possibility of malignant characteristics of these lesions. We could not find, in

the literature, any report that described a tick as the differential diagnosis

of a pigmented skin lesion. It is very important that pigmented skin lesions be

differentiated from each other. Ticks can mimic other pigmented skin lesions,

including malignant melanoma, and the tick should be considered in the

differential diagnosis of a pigmented lesion.

Hayati Akbas, MD*

Murat Hokelek, MD, PhD+

Ethem Guneren, MD*

Lutfi Eroglu, MD*

Ahmet Demir, MD*

Cafer Eroglu, MD++

O. Ata Uysal, MD*

References

1. Peter BR, Joachim K, Hilaire SJ. "The wobble sign" in epiluminescence

microscopy as a novel clue to the differential diagnosis of pigmented skin

lesions. Arch Dermatol 2000; 36: 940-942

2. Mathieu ME, Wilson BB. Ticks (including tick paralysis). In: Mandell GL,

Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 5th

ed. New York: Churchill Livingstone, 2000: 2980-2982

3. Barnhill RL. Childhood melanoma. Semin Diagn Pathol 1998; 15: 189-194

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