Description
A 62-year-old Caucasian woman was referred to dermatology by oral medicine regarding intra and extraoral hyperpigmentation which had developed gradually over the past year. Her only significant medical history was stage 4 colorectal carcinoma diagnosed 8 years previously. It was initially surgically managed with adjuvant chemo and radiotherapy, however hyperpigmentation had since recurred and was now being treated with irinotecan (topoisomerase 1 inhibitor) and cetuximab (an epidermal growth factor receptor inhibitor) for the past 1 year. She had no family history of oral or cutaneous pigmentation disorders.
On examination she was normotensive with no postural drop. Cutaneous examination revealed mild hyperpigmentation of the dorsum of her hands and fingernails bilaterally (figure 1). There were also pigmented macules on her forehead, but no pigmentation of the palmar creases. Intraoral examination showed multiple brown pigmented macules on the dorsum of the tongue and hard palate (figures 2
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