Where Is Waldo?

A 76-year-old man presented to the clinic for a total body examination. He had a personal history of five melanomas in situ, five basal cell carcinomas, and three squamous cell carcinomas. The dermatological examination revealed sun-damaged skin with three similar irregular brown macules on the left superior back, left medial trapezium, and mid-upper back (Figure 1). Dermoscopy of the three macules was comparable, revealing multicomponent features (Figure 1).

A biopsy was performed, and histology revealed one melanoma in situ and two solar lentigo (Figure 2). The melanoma was subsequently excised with 5 mm margins. Currently, the patient is being closely monitored.

In this case study, the three macules exhibited clinical and dermoscopic features that could be attributed to the diagnosis of melanoma. The presence of several nevi, extensively sun-damaged skin, and a significant history of skin cancer made the diagnosis even more challenging. Digital monitoring enables close observation and timely intervention, but in patients with suspected lesions of melanoma, early surgical excision is key. This case highlights the importance of a complete skin check and the challenge of diagnosing pigmented skin lesions in patients with severe sun damage.

Lilia Maria Lima de Oliveira: conceptualization, drafting and reviewing the manuscript, and final approval of the submitted version. Uzma Farooq: conceptualization, drafting and reviewing the manuscript, and final approval of the submitted version. Samir Ahmad: conceptualization, drafting and reviewing the manuscript, and final approval of the submitted version. Naiara Fraga Braghiroli: conceptualization, drafting and reviewing the manuscript, and final approval of the submitted version.

All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical approval is not applicable.

The authors declare no conflicts of interest.