A 45-year-old woman presents with a complaint of “a brown spot” on her back. Upon examination, you confirm there is a reticular hyperpigmented patch of skin, which she says she noticed after using a heating pad to relieve myalgia after working in her garden. She confesses that she fell asleep with the heating pad on the area, she thinks for several hours.

View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 45-Year-Old Woman with Suddenly Discolored Skin
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