Metastatic malignant melanoma associated with vitiligo-like depigmentation

Vitiligo-like depigmentation in patients with malignant melanoma is a poorly understood phenomenon. We report a patient who presented with a 4-month history of vitiligo-like depigmentation of the face, trunk and limbs. Physical examination revealed an enlarged left inguinal lymph node. A needle biopsy taken from the lymph nodes revealed metastatic malignant melanoma. One small nodule on the left sole was found subsequently. Despite the absence of junctional activity, it was considered to be a primary tumour with regression of the epidermal lesion. The patient died from sepsis, the main complication of immunosuppressive therapy, without evidence of distant metastasis. We report this case to highlight the importance of careful physical examination of patients with skin hypomelanoses. We also propose that, due to the favourable prognosis in patients with malignant melanomas and vitiligo-like depigmentation, the treatment plan may be more conservative to minimize the adverse effects of chemotherapy. © 2008 The Author(s).