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Multiple blue macules and papules on the scalp.

A 71-year-old Puerto Rican woman with a history of breast cancer was referred for dermatologic evaluation by her oncologist for re-evaluation of pigmented lesions on the scalp, initially noted eight years prior. She had no personal or family history of melanoma. Physical examination revealed a 6 mm blue papule with sixteen discreet 2-3 mm blue satellite macules within a normally pigmented 2 cm area of the left parietal scalp (Figure 1, shown after biopsy). Biopsies of the largest papule (Figures 2 and 3, hematoxylin-eosin) and a satellite were performed.