Charmaine, a receptionist in her late 50s, presents to a clinic in Far North Queensland with a nine-month history of a slowly enlarging lesion on the sole of her right foot. 

She has a strong family history of melanoma, with both parents affected in their 50s and 60s. She has had a large number of lesions excised over the years, but as yet no melanoma. She is very concerned and requests a biopsy.

Charmaine is otherwise generally well, with well-controlled hypertension and hypercholesterolaemia on candesartan 8mg and rosuvastatin 10mg respectively. 

On examination, there is an irregularly shaped, well defined, uniformly pigmented, dark tan patch on the sole of her foot (figures 1 and 2). Dermoscopy shows brown spicules in a parallel ridge pattern (figure 3). The remainder of skin and general examination is unremarkable.