Extra-facial Melasma Presenting With Isolated Forearm Involvement in a Male Patient

Melasma is an acquired disorder of hypermelanosis that most commonly affects sun-exposed facial skin in women. Extra-facial involvement and occurrence in male patients are uncommon. We present a case of a 66-year-old Hispanic male with asymptomatic, symmetric hyperpigmented patches on the bilateral forearms in the setting of chronic occupational ultraviolet (UV) exposure as a truck driver. Notably, the patient had a history of severe facial burns two years prior to presentation, with complete sparing of facial skin hyperpigmentation. A punch biopsy demonstrated increased basal layer melanin pigmentation with few dermal melanophages and no significant inflammatory infiltrate, consistent with epidermal melasma. The patient was treated with topical azelaic acid and photoprotection counseling but reported minimal improvement, likely related to ongoing UV exposure and occupational constraints. This case highlights an uncommon presentation of extra-facial melasma in a male patient and suggests that prior cutaneous injury may influence melanocytic responsiveness. It also emphasizes the role of chronic UV exposure in disease distribution and persistence.