A brown blemish on a bronzed bricklayer

Case presentation

A 62-year-old man presented with a longstanding pigmented macule on his right upper cheek (Figure 1). The lesion was first noticed five years previously and the patient reported that it had grown slowly from that time. The patient had worked for many years as a bricklayer, wearing no shirt and only a peaked cap as sun protection throughout summer. He had no personal or family history of melanoma.

On examination, an irregular and asymmetrical brown-black macule was visible that measured approximately 13 x 12 mm in diameter. Illumination with a Wood’s lamp showed the lesion to be no more extensive than could be appreciated with the naked eye.