What Is the Black Lesion on This Woman’s Lower Lip?

DermDX figure 1

A 91-year-old woman presented for evaluation of an asymptomatic dark spot on her lower lip of unknown duration. She was not aware of any recent trauma to the area and denied any new systemic medications. Her past medical history was significant for asthma and hypothyroidism. Her current medications included albuterol (inhaled when needed) and levothyroxine. Examination showed a 3x1 mm linear black macule on the central portion of her mucosal lower lip that did not blanch with diascopy (Figure 1). A punch biopsy was performed. 

What is Your Diagnosis?

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