We report the case of a 31-year-old woman from the United Arab Emirates who presented with a lesion that had been present since birth but darkened during adolescence. Following a cesarean section 1 year before presentation, she observed a reduction in girth of the left leg. She also complained of pain on exercise. Examination showed hyperpigmentation and lipoatrophy involving the entire left lower extremity, extending from the left lumbar region to the ankle (Figure). The lesion’s margins were irregular with satellite macules, reminiscent of an archipelago. The circumferences of the left and right thighs were 56 and 68 cm, respectively. There was only minimal hypertrichosis, and that was restricted to the ventral aspect of the left thigh. The patient underwent 7.5-MHz sonography, which revealed thinning of the subcutis of the left side (1.04 cm) compared with the right side (2.57 cm). Histopathologic analysis showed increased melanin production with pronounced pigmentation of the basal cell layer.