We report an unusual case of acquired dermal melanocytosis occurring in a 57-year-old African-American woman. Macular pigmentation over the patient's cheeks, back, and sclerae developed over the course of 18 months without identifiable antecedent. The patient was taking only hormone replacement therapy and was generally healthy. Histologic examination of the skin revealed dendritic melanocytes and melanophages in the mid- to upper dermis. We briefly review the literature surrounding acquired dermal melanocytosis and continue discussion regarding its pathogenesis. (J Am Acad Dermatol 2000;43:934-6.)