Presenter: Matthew Muellenhoff, DO, Thi Tran, DO, Frank Armstrong , DO, Kathleen Soe, DO, Greg Houck, DO, Marya Cassandra, DO

Dermatology Program: Sun Coast Hospital, NOVA Southeastern University Dermatology Program

Program Director: Richard Miller, D.O.

Submitted on: Nov 29, 2002

CHIEF COMPLAINT:  Two Brown Spots on the Left Hand

CLINICAL HISTORY: The patient reported a 5-year history of two brown spots on the left hand. Initially, the lesions were blue and attributed to ink stains although the patient denied contact with any staining chemicals or dyes. The “spots” increased in size over a two-year period and changed from blue to brown in color. She denied recent travel and had no history of skin cancer or atypical nevi. Family history revealed a brother with a history of melanoma. Her medications included premarin and glucosamine and she denied any allergies.

PHYSICAL EXAM:
Two brown velvety irregularly pigmented patches on the palm of the left hand.

LABORATORY TESTS:

Pigmented hyphae present on KOH preparation of lesional scraping.

DERMATOHISTOPATHOLOGY:

High power depicting inconspicuous hyperpigmented hyphae within the stratum corneum. (H+E stain, 400x)

PAS stain highlighting fungal elements in the stratum corneum. (PAS stain, 400x)

DIFFERENTIAL DIAGNOSIS:

1. Tinea nigra
2. Melanocytic lesions: junctional nevi, lentigines, and melanoma
3. Hyperpigmentation from exogenous chemical stains: silver nitrate, india in
4. Systemic disorders: Addison’s disease, tertiary syphilis, pinta and yaws