title: Mucocutaneous pigmented macule as a result of zinc deposition.
abstract: BACKGROUND
  Mucocutaneous depositions of various metals such as silver, lead, gold, arsenic, mercury, iron, and bismuth have been previously published. Heavy metal deposition typically occurs in the setting of either prolonged topical application to intact skin, topical application to eroded or ulcerated skin, as a result of either parenteral administration, or due to penetrating traumatic exposure.
  
  
  METHODS
  We report a unique case of mucocutaneous pigmentation occurring in a snow skier after topical application of a zinc-containing sunblock. Formalin-fixed paraffin-embedded tissue was utilized for electron microscopy.
  
  
  RESULTS
  Backscatter electron imaging and energy dispersive spectroscopy revealed that the dominant metal present was zinc.
  
  
  CONCLUSIONS
  Mucocutaneous deposition of metals is enhanced by damage to the surface epithelium. Metal-containing topical agents, although commonly used, may rarely result in a permanent pigmentary alteration. We believe similar cases of mucocutaneous deposition of zinc exist; however, as these may be currently misdiagnosed as amalgam tattoos, the true incidence of this disorder is presently undefined.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, Center for Advanced Microscopy, University of Miami, FL, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Greenberg
authors.forename: M
authors.initials: M
authors.lastname: Lynn
authors.forename: R S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: G W
authors.initials: GW
authors.lastname: Elgart
authors.forename: A J
authors.initials: AJ
authors.lastname: Hanly
mesh_terms: D000328:Adult; D020405:Dermis / Q000187:drug effects* / Q000378:metabolism / Q000648:ultrastructure; D004577:Electron Probe Microanalysis; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D008855:Microscopy, Electron, Scanning; D009092:Mucous Membrane / Q000187:drug effects* / Q000378:metabolism / Q000648:ultrastructure; D015032:Zinc / Q000009:adverse effects* / Q000032:analysis / Q000378:metabolism
chemical_list: D015032:Zinc