Diffuse Melanosis Cutis
A 76-year-old man was admitted to the hospital because of increasing generalized weakness. Several weeks earlier, a progressive gray–blue discoloration of the skin had developed. Because of the pronounced change in skin color, this white patient was no longer recognizable on his identity card. A malignant melanoma that was negative for the BRAF mutation had been diagnosed 14 months earlier, and multiple metastases of the liver and spleen had been detected 5 months earlier. He had received four cycles of dacarbazine after detection of the metastases. The remarkable hyperpigmentation of his skin was a consequence of diffuse melanosis cutis. Melanosis cutis is considered to be an ominous sign and is associated with a median survival of 6 months. However, this patient lived for an additional 16 months after the development of melanosis cutis, perhaps as a result of immunotherapy with ipilimumab.