Generalized melanosis and melanuria in a patient with metastatic melanoma
We describe a case of generalized melanosis and melanuria in a patient with metastatic melanoma and review the pathogenesis and prognostic implications of this phenomenon. A 62-year-old-man with Fitzpatrick skin type II presented with a 3-month history of changes in a mole on his back. Histological examination of a biopsy found an incompletely excised superficial spreading melanoma (Breslow thickness 9 mm, Clark level V, nonulcerated, perineural and perivascular invasion, mitotic rate 21 ⁄ mm) with microsatellite deposits at the deep margin. A whole-body positron emission and computed tomography (PET-CT) scan revealed no evidence of distant metastatic disease, and baseline liver profile, full blood count and lactate dehydrogenase (LDH) level were normal. A 20-mm wide local excision down to the fascia was performed and reported as an incompletely excised in-transit metastasis. Fourteen months after the initial surgery, the patient presented with a 3-month history of right-sided chest pain, and diffuse slate-grey hyperpigmentation of the PD