A 87-year-old Caucasian women had a recurrent pigmented tumor on the back. Histologically, the lesion was interpreted as being a melanoacanthoma. It was characterized by a proliferation of unpigmented basaloid cells with aggregates of large prickle cells, forming small horn pearls; furthermore the tumor contained numerous large dendritic cells with large amounts of melanin granules. A short review of the literature is followed by the discussion of the relationship between melanoacanthoma and irritated seborrheic keratosis.