History
A 37-year-old man with congenital giant and multiple pigmented
lesions and a 6-month history of seizures was referred to the
Department of Dermatology for further evaluation. His past medical
history was unremarkable except for the presence of large and
numerous congenital pigmented nevi distributed over his body. He
was healthy and had no other complaints until the first
neurological symptoms developed. A few months later he was examined
by a neurologist after a Grand-mal episode with complaints of
headache and slurred speech. Raised intracranial pressure led to
mild signs of hydrocephalus. Funduscopy showed papilledema. Cranial
computed tomographic (CT) examinations and magnetic resonance
imaging (MRI) of the brain with intravenous contrast revealed
meningeal involvement, dilated ventricles and a well-defined oval
2.0 x 1.8 cm contrast-enhanced mesencephalic mass localized at the
left parieto-occipital part ( Fig. 1 ). A lumbar puncture was not
diagnostic. Temporal craniotomy was performed, and several biopsies
were taken from the tumor. Histological analysis of the specimen
and immunohistochemistry with S100, MelanA, Vimentin and HMB 45
revealed a metastasis of malignant melanoma ( Fig. 2A and B ). A
week later the patient was admitted to our hospital for further
evaluation of pigmented lesions and search of the primary malignant
melanoma.


