Darkish discoloration of skin involving the back, neck, and upper arms

Presenter: Christopher Buckley, DO; Marcus Goodman, DO; Allison Schwedelson, DO; Angela Combs, DO; Matthew Elias, DO; Emily Rubenstein, DO; Carlos Gomez-Meade, DO; Julian Moore, DO; Rupa Reddy, DO

Dermatology Program: NSUCOM/Broward General Medical Center

Program Director: Stanley Skopit, DO

Submitted on: December 23, 2009

CHIEF COMPLAINT: Darkish discoloration of skin ongoing for several years

CLINICAL HISTORY: 58-year-old Hispanic male with HTN (not on medication) presented with darkish discoloration of skin involving the back, neck, and upper arms. The discoloration was ongoing for several years. No associated pruritus, pain, or previous skin lesions. No new medications. No prior treatments.

PHYSICAL EXAM:
Hyperpigmented blue-gray macular eruption coalescing into patches on the anterior shoulders, neck, upper extremities, back, and mid-chest. No overlying scale or erythema.

LABORATORY TESTS:

CBC, CMP, thyroid were within normal limits.

DERMATOHISTOPATHOLOGY:

Mild basal cell layer vacuolar degeneration overlying an upper dermis with a mild perivascular mononuclear cell infiltrate and increased melanophages.