Intended for healthcare professionals

Endgames Spot Diagnosis

A woman with an itchy hyperpigmentation on her back

BMJ 2019; 365 doi: (Published 11 April 2019) Cite this as: BMJ 2019;365:l1332
  1. Lieke Hondebrink, general practitioner in training,
  2. Wim Opstelten, general practitioner
  1. Health Center Vondelplein, Amersfoort, Netherlands
  1. Correspondence to W Opstelten w.opstelten{at}

A 67 year old woman with a known history of type 2 diabetes and hypertension visited our general practice because of an itchy skin patch on her back. It had been there for several years and had become darker. She did not have any previously documented dermatological history. On physical examination, we observed an ill defined, slightly raised brownish patch, approximately the size of an adult hand, below her left scapula (fig 1). She had slightly reduced sensation over the affected area on …

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