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A 3-year-old girl presented with a 2-year history of hyperpigmentation on her left palm. First, the girl’s parents accidentally found an asymptomatic pale brown spot the size of a rice grain on her left palm, which did not disappear after scrubbing. Later, the number of pale brown spots gradually increased and subsequently spread and merged with one another, forming irregular pale brown patches. The lesion was diagnosed as an acral naevus or acral melanoma. The girl had no history of trauma prior to disease onset or any history of flower or soil contact, did not live in a rural or coastal area, and did not have any history of systemic diseases. Physical examination revealed a brown non-scaly macule with a geographic shape, which measured 1.5×1.5 cm in diameter and was present on the left palmar area. It had sharp borders without scales or signs of inflammation (Fig. 1).

Hyperpigmentation on the Palm in a Three-year-old Girl: A Quiz