A 75-year-old woman who was positive for metastatic breast cancer and left radical mastectomy complained of two month-history of dirty-appearing skin, composed of subtle but clear-cut brown to blackish areas with a velvety texture, symmetrically involving lateral sides of trunk and proximal upper limbs, chest, abdomen and the whole dorsum (Fig. 1). The discoloration was apparently unrelated to patient's medications, whereas showers and brushings with acid liquid soap did not lead to significant improvement.
