A 5-year-old girl presented with a single small lesion on her back. The lesion had been present for at least 4 years and had not changed significantly in size. It did not bother the patient. She had a history of eczema.

Physical examination revealed a brown, targetoid, macular lesion approximately 6 mm in diameter on the patient's upper back (Figure 1). It was not tender or pruritic.

QUESTION

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Cockade nevus.

• B. Eczematous nevus.

• C. Erythema multiforme.

• D. Halo nevus.

DISCUSSION

The answer is A: cockade (or “target”) nevus, a benign lesion that usually occurs in young children on the trunk or scalp. It presents as a central pigmented area encircled by a separate pigmented ring, thus resembling a target.¹ On dermoscopic examination, the central pink to brown area is typically homogenous, and the outer pigmented circle appears as a reticular ring.²