A black mark on a bowler’s forearm
A 65-year-old woman presented for the first time for skin examination. A family history of nonmelanoma skin cancer had prompted her to seek reassurance regarding a number of longstanding lesions, including a deeply pigmented plaque on the arm that had drawn concern from a number of friends. The lesion had probably been present for more than 20 years but had slowly darkened with time. She enjoyed an outdoor lifestyle, having played lawn bowls and tennis for many years, but she was lax with sun protection on the arms, where she was habitually tanned.