Ahmed A. EL-Emawy, MD

This 28-year-old woman presented with a large hyperpigmented patch on the right side of her upper back. Although the lesion developed over the past 2 years, it has been "sinking in" over the past 2 weeks. The patient denies any trauma, pain, discomfort, or pruritis, as well as any family history of cancers, lymphoma, or autoimmune disease. However, she has a history of gastroesophageal reflux disease and onychomycosis, and her grandfather has a similar lesion.