Dark follicular orifices

Case presentation

A 78-year-old woman presented with a lesion on her left cheek. It had been frozen nine years before the consultation and had subsequently recurred. The sharply demarcated lesion was dark tan and measured 2 cm x 1 cm (Figure 1). Dermatoscopy revealed multiple dark follicular orifices resembling pigment globules (Figure 2). These varied in size, and many were patulous. The surrounding background lesion had an orange–brown hue and a scalloped border. There was no pigment network visible. Skin biopsy revealed a hyperpigmented epidermis, but the number of melanocytes was normal and there was no atypia (Figure 3).