A 32-year-old white woman sought treatment at the oral medicine service at the University of Pennsylvania Medical Center, Philadelphia. She had multiple areas of asymptomatic focal pigmentation of four weeks' duration on the left buccal mucosa (Figure 1). Her medical history was significant for eczema and for a recent sinus infection treated with multiple courses of cefdinir. The patient's medications included prenatal vitamins and calcium supplement, she reported having a true allergy to neomycin, and she denied using tobacco or alcohol. We obtained a 4-millimeter punch biopsy specimen from the affected area without incident and sent it to an oral and maxillofacial pathologist for histologic evaluation (Figure 2).
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