Abstract

Cutaneous argyria is a condition acquired by exposure to silver. It is considered a diagnostic challenge because the clinical presentation may mimic more common dermatologic conditions including melanocytic nevi and melanoma.  A 61-year-old male presented with a non-changing blue and black macule with irregular borders on the proximal interphalangeal joint of the right fifth finger for approximately 10 years.   The clinical impression was of a blue nevus.   A skin biopsy showed brown and black granular structures within the basement membrane, compatible with argyria, together with yellow-brown deposits in the interstitial dermis histologically resembling ochronosis.   Further inquiry revealed an occupational history as a police officer for 12 years and frequent handling of guns which could have caused localized exposure to silver. This case highlights a rare presentation of localized argyria with pseudo-ochronosis and reinforces the value of a detailed clinical history and the importance of including argyria in a differential diagnosis for melanocytic lesions.