A 65-year-old, healthy woman presented to our clinic for evaluation of a brown “spot” on her upper lip. She had first noticed the gradual onset of the lesion several months earlier. Since that time, it had not changed color, shape, or size. There was no pain or pruritus. The patient stated that she had not used any OTC treatments on the area. Recently, she had noticed similar lesions appearing on her dorsal hands and forearms. Questioning revealed that she played tennis outdoors three times a week, and she reported sporadic sunscreen use.


The patient, a 63-year-old man of Swedish descent, was concerned about a freckle on his cheek that had been darkening gradually over the past year. According to the man, the lesion’s borders were also changing, and part of the lesion was now “bumping out.” There was no pruritus or pain, and the growth did not bleed. The patient had not sought any form of treatment. No weight loss, fatigue, or adverse symptoms were found. On further questioning, the man revealed that he had worked as a gardener for 40 years and had spent many hours in the sun each day.

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