Access Dermatology

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.