-34 year old female presented to her dermatologist with a changing pigmented lesion on her left shoulder.

-The patient had multiple prior compound and dysplastic nevi removed from her back and abdomen

-The patient thought that this may have been the site of a prior biopsy, but she was not certain

-Clinically, there was a 9mm irregularly shaped macular pigmented lesion with variable pigmentation

-The lesion was biopsied and showed the following: