Ann Dermatol.  2009 May;21(2):178-181. 10.5021/ad.2009.21.2.178.

Vitiligo-like Depigmentation Associated with Metastatic Melanoma of an Unknown Origin

• Cho EA
• Lee MA
• Kang H
• Lee SD
• Kim HO
• Park YM

• KMID: 2219391
• DOI: http://doi.org/10.5021/ad.2009.21.2.178

Abstract

Although malignant melanoma usually occurs after the diagnosis of vitiligo-like depigmentation, the latter is rarely followed by the former. We herein report on such a case in which recognition of the vitiligo-like depigmentation preceded diagnosing the metastatic melanoma by several months. A 56-year-old woman had first developed vitiligo-like depigmentation on the forehead, eyelids, neck and back 18 months previously and thereafter she detected a hard mass in the left axilla 2 months previously. Based on the histologic findings, the axillary mass was diagnosed as metastatic melanoma. To evaluate the primary tumor focus, thorough examinations that included PET-CT, bone scan and sigmoidoscopy were performed, but we couldn`t find any the original primary tumor. Our case suggests that the vitiligo-like depigmentation could be a sign that heralds metastatic melanoma.

Keyword

Metastatic melanoma; Vitiligo-like depigmentation

MeSH Terms

Axilla
Eyelids
Female
Forehead
Humans
Melanoma
Middle Aged
Neck
Sigmoidoscopy

Figure

• 

  Fig. 1 Vitiligo-like lesions on the forehead, eyelids and back.

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  Fig. 2 A lobulated lymph node mass 5.4×3.1 cm in dimension with inhomogeneous enhancement in the left axilla.

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  Fig. 3 (A) The biopsy specimen from the axillary lymph node mass shows the tumor nests (H&E, ×100). Inset: The tumor nests are composed of atypical, epitheloid cells with hyperchromatic, pleomorphic nuclei and some mitoses (H&E, ×400). (B) The tumor cells stained positive for S-100 protein (left: S-100, ×200) and they were positive for HMB-45 (right: HMB, ×200).

Reference

1. Ortonne JP, Gauthier Y, Guillet G, Gauthier O. Hypomelanosis of the skin and malignant melanoma. Ann Dermatol Venereol. 1978. 105:1043–1052.

2. Duhra P, Ilchyshyn A. Prolonged survival in metastatic malignant melanoma associated with vitiligo. Clin Exp Dermatol. 1991. 16:303–305.

3. Nordlund JJ, Kirkwood JM, Forget BM, Milton G, Albert DM, Lerner AB. Vitiligo in patients with metastatic melanoma: a good prognostic sign. J Am Acad Dermatol. 1983. 9:689–696.

4. Kiecker F, Hofmann M, Sterry W, Trefzer U. Vitiligo-like depigmentation as a presenting sign of metastatic melanoma. J Eur Acad Dermatol Venereol. 2006. 20:1135–1137.

5. Berd D, Mastrangelo MJ, Lattime E, Sato T, Maguire HC Jr. Melanoma and vitiligo: immunology's Grecian urn. Cancer Immunol Immunother. 1996. 42:263–267.

6. Schallreuter KU, Levenig C, Berger J. Vitiligo and cutaneous melanoma. A case study. Dermatologica. 1991. 183:239–245.

7. Merimsky O, Shoenfeld Y, Yecheskel G, Chaitchik S, Azizi E, Fishman P. Vitiligo- and melanoma-associated hypopigmentation: a similar appearance but a different mechanism. Cancer Immunol Immunother. 1994. 38:411–416.

8. Arpaia N, Cassano N, Vena GA. Regressing cutaneous malignant melanoma and vitiligo-like depigmentation. Int J Dermatol. 2006. 45:952–956.

9. Cui J, Bystryn JC. Melanoma and vitiligo are associated with antibody responses to similar antigens on pigment cells. Arch Dermatol. 1995. 131:314–318.

10. Yee C, Thompson JA, Roche P, Byrd DR, Lee PP, Piepkorn M, et al. Melanocyte destruction after antigen-specific immunotherapy of melanoma: direct evidence of t cell-mediated vitiligo. J Exp Med. 2000. 192:1637–1644.

11. Le Gal FA, Avril MF, Bosq J, Lefebvre P, Deschemin JC, Andrieu M, et al. Direct evidence to support the role of antigen-specific CD8(+) T cells in melanoma-associated vitiligo. J Invest Dermatol. 2001. 117:1464–1470.

12. Hornung MO, Krementz ET. Specific tissue and tumor responses of chimpanzees following immunization against human melanoma. Surgery. 1974. 75:477–486.

13. Cui J, Chen D, Misfeldt ML, Swinfard RW, Bystryn JC. Antimelanoma antibodies in swine with spontaneously regressing melanoma. Pigment Cell Res. 1995. 8:60–63.

14. Ohsie SJ, Sarantopoulos GP, Cochran AJ, Binder SW. Immunohistochemical characteristics of melanoma. J Cutan Pathol. 2008. 35:433–444.

15. Bystryn JC, Rigel D, Friedman RJ, Kopf A. Prognostic significance of hypopigmentation in malignant melanoma. Arch Dermatol. 1987. 123:1053–1055.

16. Koh HK, Sober AJ, Nakagawa H, Albert DM, Mihm MC, Fitzpatrick TB. Malignant melanoma and vitiligo-like leukoderma: an electron microscopic study. J Am Acad Dermatol. 1983. 9:696–708.