Derm Dx: Irregular, discolored brown spot on the cheek

A patient, aged 88 years, presented for evaluation of a brown spot on her cheek. The lesion had been present for five years and had recently darkened and enlarged.

Examination revealed a 2.5 cm x 1.5 cm irregularly shaped macule with varying degrees of coloration. Moderate actinic damage, consisting of mottled pigmentation, telangiectasia, and rhytides, was noted as well.