Side Abdominal Pain and Skin Moles: When to Worry? - Family Medicine

Dr. Xiao Yongxun reply Family Medicine

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Dear Mr.
Zheng:
1.
Pneumothorax refers to the presence of air or any gas in the pleural cavity, which can occur due to trauma, medical procedures, or unknown reasons.
If the lesion creates a one-way valve effect, allowing air to enter the pleural cavity only during inhalation and preventing its escape during exhalation, the lung may become compressed and collapse over time, potentially leading to mediastinal shift; this condition is known as tension pneumothorax.
Clinically, it can range from asymptomatic to severe emergencies with symptoms such as chest pain, shortness of breath, and even respiratory failure.
Symptoms of rib fractures are caused by pain from broken ribs, particularly exacerbated by deep breathing, pressing on the affected area, bending, or twisting the body.
Based on your description of "a sudden aching in the rib area...
although it no longer hurts...", it does not strongly suggest a rib fracture or pneumothorax.
If you remain concerned or have questions, I recommend discussing this with your primary care physician or visiting a thoracic surgery outpatient clinic at a regional hospital.
2.
It is common for individuals to have several melanocytic nevi (moles).
These nevi typically appear as round brown spots or slightly raised papules, with smooth borders and a clear distinction from normal skin, exhibiting relatively uniform color.
Nevi begin as a proliferation of melanocytes located in the basal layer of the epidermis, where many cells cluster together.
At this stage, the proliferating melanocytes are located at the dermoepidermal junction, clinically presenting as flat spots or papules known as junctional nevi.
As melanocytes gradually migrate into the dermis, both the epidermis and dermis will contain melanocytes, at which point they are referred to as compound nevi.
Eventually, all nevus cells may migrate into the dermis, forming intradermal nevi.
During this migration process, the melanin content decreases, and the cells change from round to spindle-shaped, a process known as maturation; this change is an important benign phenomenon in melanocytic proliferation that helps differentiate it from malignant melanoma.
The differentiation of melanocytic nevi relies on pathological examination of tissue samples.
Clinically, if a melanocytic nevus presents with large nodules, uneven color, irregular borders, or symptoms such as itching, ulceration, or bleeding, one should suspect malignant melanoma.
Additionally, if skin tumors appear in sun-exposed areas, such as the face and the back of the arms, or if there are red, light brown, or normal skin-colored spots or patches with a rough surface covered by thick keratin and scaling, one should consider the possibility of squamous cell carcinoma.
If there are pearly nodules or papules with visible dilated blood vessels in the dermis, which may appear brownish due to melanin, and if longstanding lesions develop ulceration, basal cell carcinoma should be considered.
Given the many factors to consider and differential diagnoses, clinicians typically advise patients to "monitor for sudden enlargement or bleeding and follow up as needed." If you remain concerned or have questions, I recommend discussing this with your primary care physician or visiting a dermatology outpatient clinic at a regional hospital.

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Reply Date: 2020/05/30