History: This 63-year-old male presented with maculo-papular pigmented skin lesions all over his body, more accentuated on the flexural surfaces that started at a slow rate one year ago, but increased rapidly over the past 5 months. History of similar lesions in his grandmother. Sections show a biopsy of skin in which there is hyperkeratotosis, papillomatosis, acanthosis as well as pseudohorn cysts. Basal layer shows increased pigmentation.