The diagnosis of pigmented lesions is a daily challenge in general practice. Dermoscopy can provide extra clues, but requires significant expertise.
Over an 18-month period, a 62-year-old man developed twin pale erythematous papules with punctate crusts and pigment over his right shin. Dermoscopy showed brown to blue–grey globules and dots irregularly distributed over a pale background with telangiectasia and blood. Skin biopsy revealed focally pigmented basaloid lobules that penetrated into the superficial dermis.