Eruptive Mucosal and Ungual Melanoma Metastases
A 47-year-old man presented to the dermatology clinic with a 10-day history of multiple fingernail, oral, and penile lesions associated with fever, decreased appetite, and nausea. His medical history was notable for cutaneous melanoma on the chest that had been treated 11 years earlier with surgical excision. The physical examination showed multiple discrete, pigmented lesions on the hard and soft palates, as well as below the tongue (Panels A and B). He had similar lesions on the penis. Examination of the hands showed numerous longitudinal dark bands on the nail bed of multiple fingers (Panels C and D). A biopsy of one of these lesions confirmed the presence of melanoma cells, a finding consistent with a diagnosis of mucosal and ungual melanoma metastases. Further evaluation of the patient’s gastrointestinal symptoms revealed gastric metastases, and a BRAF mutation was identified by molecular analysis. The patient was treated with dabrafenib and trametinib, and partial regression of the lesions was seen at a 5-month follow-up visit.