Minocycline therapy should be included in the differential diagnosis of hyperpigmented scars. Careful history taking and even repeated questioning may be necessary to elicit an accurate medication history. The pigmentation is most likely due to a minocycline metabolite, bound to iron; Fontana-Masson positivity may result from the action of reducing agents other than melanin. Slow resolution of the pigment can be expected following discontinuation of the drug. Nevertheless, biopsy is indicated when, as in this case, an atypical pigmented skin lesion raises concerns about malignant melanoma.