History of the present illness

An 87-year-old non-smoking Asian woman presented with a three-year history of hyperpigmented macules on the buccal mucosa (Figure 1), tongue, maxillary edentulous alveolar ridge, hard and soft palate and lips. The macules are irregular, 4-8 mm in size and are dark brown to black in color. They are otherwise not palpable or indurated. The patient reports that they were first noticed three years ago and that they have increased in number over time.

Figure 1 This is a photograph representing the buccal mucosa with multiple darkly pigmented macules. Note the lack of uniformity in color as well as in shape and size.