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Discoloration on Palm That Won't Wash Off

Discoloration on Palm That Won't Wash Off

A 42-year-old homemaker noticed a discoloration on her palm. There were no symptoms, but she was greatly perturbed by her inability to wash this “dirt” off her skin with soap and water, as well as a slow but definite expansion of the spot in question. At this point, she sought dermatology consultation. The patient was in excellent health, took no medications, and had a negative family history for malignant melanoma. Despite being an avid gardener, especially at her Galveston beach house, she denied a history of trauma to the affected area. The most likely diagnosis is:

A. Resolving hematoma
B. Tinea nigra palmaris
C. Acral lentiginous malignant melanoma
D. Insect bite

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