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To report a case of post-operative pigmentation in a full thickness skin graft after excision of a melanoma which was spontaneously resolved.

In this case, a 74-year-old woman presented with a three-month history of a right lower lid lesion.  The patient had a history of sun exposure and was a non-smoker. The lesion was approximately 5cm by 4cm in size and had diffuse heterogeneous pigmentation with irregular borders and nodular texture. Histology confirmed the lesion was localised and consistent with a diagnosis of stage 1 lentigo maligna melanoma.  The patient underwent a complete excision and repair with a full thickness skin graft from the ipsilateral upper lid to the lower lid.

Post-operatively the patient developed patchy pigmentation within the graft itself. This was suspicious and monitored closely for signs of reoccurrence of melanoma. Serial photographs were taken at each visit and over time the pigmentation spontaneously resolved and the graft returned to its normal texture and colour.

Post-surgical pigmentation is not a common sign in graft tissue from the upper lid. There is no reliable predictor of the expected response and predictor of disease activity in melanoma lesions post skin grafting.

To date, there have been no reported cases of spontaneous resolution of pigmentation in graft tissue, where previous melanoma had been excised. This is the first reported case of its kind and should provide surgeons reassurance that post-operative pigmentation in graft tissue may not always be a suspicious sign of reoccurrence of melanoma.