Supernumerary nipples through the lens of a dermoscope

A 17-year-old male undergoing acne evaluation had three asymptomatic brown abdominal lesions with thick hair, unchanged since childhood [Figure 1a-c]. Similar lesions were noted in his mother and sister. Systemic examination was unremarkable.

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Figure 1: (a) Brown lesions one on right and two on the left of midline on the abdomen, (b) 0.5 × 0.5 cm brown raised lesion located on the right milk line, (c) a 0.25 × 0.25 cm brown papule just above the umbilicus on the left milk line, a small brown macule seen below the umbilicus on the left milk line, and with 1-2 darker and thicker hairs compared to the surrounding vellus hairs observed in both lesions.

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Dermoscopy showed a pigmented network with a central cleft (right lesion), a central scar-like area (upper left lesion), and cobblestone-patterned light-colored angular specks (lower left lesion) [Figure 2a-c]. A diagnosis of supernumerary nipples (SN) was made based on clinical location, familial occurrence, and dermoscopic features.

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Figure 2: (a) Dermoscopy showing interconnected dark brownish thin lines forming a pigment network on a diffuse tan background, with a small cleft-like feature at the center, (b) central structureless white scar-like area with prominently thick, dark hair compared to surrounding vellus hair, (c) light-colored angulated specks clustered together in a cobblestone pattern (Dermlite DL4; ×10, polarized mode).

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SNs (1–6% incidence) are congenital anomalies affecting both sexes, typically forming along milk lines or ectopically on the chest, abdomen, thighs, or arms. Inheritance may be sporadic or familial.^[1] Systemic associations, particularly genitourinary anomalies, are notable and carry an increased malignancy risk.^[2] Associations with genetic syndromes such as Turner syndrome, trisomy 8, trisomy 2p, Fleisher’s syndrome, Char syndrome, and neurofibromatosis type 1 have been documented.^[3]

Dermoscopy helps differentiate SN from dermatofibromas and nevi. Recognizing SN as a genodermatosis with malignancy risk, especially in ectopic cases, is crucial.