Giant cutaneous melanoacanthoma

A 45-year-old male cook was seen for the evaluation and removal of a "mole on my eye" of steady growth during the previous 6 months. The patient stated that he had had a "brown spot" above his left eye for 17 years prior to its recent enlargement; it was now partly blocking the vision in his left eye. He denied a history or family history of cutaneous tumors, including skin cancer. On examination, a 2.5-cm × 0.5-cm × 0.8-cm, horn-like, darkly pigmented, cutaneous nodule was evident extending from the left upper eyelid downwards to below the lower eyelid (Figs 1 and 2). He also had scattered, skin-colored, 2-3-mm cystic papules on his anterior mid-chest. A shave excision specimen was obtained from the eyelid nodule. Microscopic examination demonstrated acanthosis, hyperkeratosis, and papillomatosis (Fig. 3). Large dendritic cells with abundant melanin granules were spread throughout the epidermis. In addition, small basaloid or spinous keratinocytes were present in the malpighian layer.