Several tiny, dark lesions developed on the face and neck of a 57-year-old man over a 3-year period. He had experienced a 4.5-kg weight loss in the 6 months prior to presentation. Examination revealed more than 30 discrete, uniformly black macules and barely indurated papules measuring 1 to 2.5 mm scattered bilaterally over the forehead, face, neck, and chest (Figure 1 and Figure 2). One month after biopsy, a 1-cm margin of hypopigmentation developed on a lesion that had been present on the patient's chest for 3 years; none of the other lesions had accompanying erythema or halos. There was a subungual hyperpigmented streak of the left third finger (Figure 3). There was no regional adenopathy. No primary pigmented lesion or area of depigmentation was found. The biopsy specimens showed similar histologic findings (Figure 4).
Rye B, Webb JM. Pigmented Papules and Weight Loss. Arch Dermatol. 1998;134(7):861-866. doi: