Recently, an 84-year-old Caucasian woman was referred to our skin cancer unit because of an asymptomatic nodule on the right leg for the preceding 4 months, with no personal or family history of melanoma or nonmelanoma skin cancer. Physical examination showed a well-defined, reddish nodule measuring 1 cm in diameter (Figure 1A). Dermoscopy revealed yellowish structureless areas, white lines, and irregular, hairpin-shaped and curved vessels (Figure1B). Due to suspicions of melanoma, an excisional biopsy was performed for histopathological examination. Hematoxylin and eosin (H&E) staining showed an atypical melanocytic proliferation, with an architecturally disorganized, predominantly intradermal component composed of cells containing hyperchromatic pleomorphic nuclei and a ballooned appearance with vacuolated cytoplasm, mitotic figures, and discrete areas of intradermal pagetoid spread (Figure 2, A and B). No ulceration, lymphovascular and perineural invasion, satellitosis, or regression was noted. Breslow thickness was 4.1 mm with moderate mitotic activity with 4 mitotic figures seen per square millimeter. Immunohistochemical staining showed positive results for melanocytic markers S100 (Figure 2C), HMB45 in the dermal component, and MELAN-A, confirming the diagnosis of BCM. Ki67 Ki67 staining was positive in balloon cells.