a Persistent Black Spot on the Sternum: Causes and Concerns - Family Medicine

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The persistent black spot on your sternum, which exhibits changes during episodes of fever or illness, raises several important considerations. Based on your description, it appears that the spot is asymptomatic under normal conditions but becomes red, swollen, and itchy during illness, with a tendency to peel afterward. This pattern suggests a possible dermatological condition that may be exacerbated by systemic factors such as infection or inflammation.


Possible Causes
1. Seborrheic Keratosis: This is a common benign skin growth that can appear as a black or brown spot. It is usually harmless and does not cause pain or discomfort. However, it can become irritated or inflamed during illness, leading to the symptoms you describe.

2. Lentigo: This is a flat, brownish spot on the skin that can darken with sun exposure or other factors. While typically benign, it can sometimes become inflamed or itchy, especially if there is an underlying skin condition or irritation.

3. Dermatitis: Contact dermatitis or other forms of eczema could explain the itching and inflammation. If the area is scratched, it may become more inflamed and lead to secondary changes like peeling skin.

4. Fungal Infection: Certain fungal infections can present as dark spots on the skin and may become more pronounced during illness or when the immune system is compromised. The itching and inflammation could be indicative of a fungal infection that flares up during times of illness.

5. Psoriasis: This chronic autoimmune condition can cause red, scaly patches on the skin. While it typically presents with silvery scales, it can sometimes appear as dark spots, especially if the skin is scratched or irritated.

6. Skin Cancer: Although less likely given the benign nature of your symptoms, any persistent change in the skin, especially one that grows or changes over time, should be evaluated for potential malignancy. Basal cell carcinoma or melanoma can sometimes present as dark spots.


Recommendations
1. Dermatological Evaluation: Since you have already seen an internal medicine specialist without a definitive diagnosis, it would be prudent to consult a dermatologist. They can perform a thorough examination and may recommend a biopsy of the spot to determine its nature.

2. Monitoring Changes: Keep a close eye on the spot for any changes in size, color, or symptoms. Documenting these changes can provide valuable information for your healthcare provider.

3. Avoid Scratching: While the itching can be intense, try to avoid scratching the area as this can lead to further irritation and potential infection.

4. Symptom Management: Over-the-counter antihistamines may help alleviate itching during flare-ups. Additionally, applying a gentle moisturizer can help soothe the skin.

5. Consider Systemic Factors: Since the spot becomes more pronounced during illness, it may be worth discussing with your healthcare provider any underlying conditions that could be contributing to your skin's sensitivity or response to illness.


Conclusion
While the black spot on your sternum may not be causing significant issues at present, its persistent nature and the changes you observe during illness warrant further investigation. A dermatologist will be best equipped to provide a definitive diagnosis and appropriate management. Remember, early evaluation and intervention are key to addressing any potential skin concerns effectively.