case_images: PMC3081490_01
case_images: (a) Pigmentation on the lower lip
case_images: JCAS-4-58-g001.jpg
case_images: PMC3081490_01_JCAS-4-58-g001.jpg
case_images: F0001
case_images: There were brown colored pigmented macules 1-3 mm in size on lower lip [Figure 1a]. There was slate-gray pigmentation of the tongue [Figure 1b]. Examination of hands revealed round to oval well-defined brown-colored macules 1-5 mm in diameter on the palmar aspect of the tips of all the fingers [Figure 1c]. Similar pigmentation was seen on tips of all the toes [Figure 1d].
case_images: (b) Pigmentation on the tongue
case_images: JCAS-4-58-g002.jpg
case_images: PMC3081490_01_JCAS-4-58-g002.jpg
case_images: F0002
case_images: The thumb nails showed longitudinal brownish black vertical bands 5-7 mm thick in size [Figure 2].
case_images: (c) brownish - black pigmentation on tips of fingers
case_images: JCAS-4-58-g003.jpg
case_images: PMC3081490_01_JCAS-4-58-g003.jpg
case_images: F0003
case_images: A skin biopsy was taken from the macule on the left thumb, which revealed marked hyperkeratosis and acanthosis and increased amount of melanin in the basal layer of the epidermis [Figure 3].