A new plum-coloured papule

Case presentation

Over a two-month period, a 76-year-old man developed a smooth plum-coloured papule (measuring 7 mm x 4 mm in diameter) on his left thigh (Figure 1). Dermoscopy of the papule revealed an oval grey–blue lesion with a superimposed milky veil (Figure 2). The surrounding skin was sun-damaged and had mottled pigment. The excision biopsy contained a subepidermal nodule consisting of sheets of pleomorphic and focally pigmented melanocytes separated by a vascular network (Figure 3). Review of the patient’s history revealed that nine years before the consultation, a melanoma had been removed from his left calf. Over the ensuing five years, four solitary metastases localised to the left leg had been surgically excised.