A recent pale nodule with pseudocysts The diagnosis of pigmented lesions is a daily challenge generally practice. Dermoscopy can offer extra clues, but requires significant expertise. Case presentation Over a one-month period, an 85-year-old guy noted the development of a pale pigmented nodule in a tan-coloured macule that were present for five years on his still left shin. Biopsy of the nodule revealed bedding of atypical spindle cells with mitoses within the dermis and scant melanin pigment.Previous approaches to identifying susceptibility genes have used genomewide association studies or candidate-gene approaches.31-33 Our identification of rare COQ2 variants was accomplished by you start with multiplex families and extending the analysis to individuals with sporadic multiple-system atrophy, reflecting an alternative approach to the elucidation of genetic variants with strong effect sizes in an apparently non-genetic disorder.34 From the therapeutic viewpoint, oral supplementation with coenzyme Q10 could be helpful in treating multiple-system atrophy, for sufferers with susceptibility-conferring COQ2 variants particularly. The protection and side-effect profile of high-dosage supplementation with coenzyme Q10 have been well established.35,36 Addendum Human COQ2 contains 4 ATG codons in exon 1.