A 59-year-old woman with a pre-existing asymptomatic pigmented nevus on the umbilicus for the past 20 years was seen in the outpatient dermatology clinic for a 2-week history of a raised, bleeding pigmented papule overlying the nevus. Physical examination showed a 7 x 7mm ulcerated papule overlying a 2.2 x 1.8cm darkly pigmented patch over the umbilicus, and dermoscopy showed an asymmetrical, homogeneously hyperpigmented ulcerated papule atop a similarly hyperpigmented lesion with irregular borders.
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