Generalized melanosis complicating disseminated malignant melanoma in pregnancy: A case report

Abstract

A case of generalized melanosis complicating disseminated malignant melanoma in pregnancy is described. Four features of this case, unique in combination, are discussed. First, generalized melanosis is a rare complication in macrophages of skin and other areas. Secondly, extensive bone lesions in the absence of roentgenographic changes are an uncommon occurrence. Thirdly, pregnancy probably has little effect on the course of melanoma, as illustrated by this case and a review of the literature. Finally, placental metastases may be more common than generally thought, yet may have little significance to the fetus.

Malignant Melanoma with Melanosis

“…Since that time a number of eases have been described jn which the hyperpigmentation resulted from widespread dissemination melanoma cells (Dawson 1925, Way & Light 1930. These differ from the true cases of melanosis in whieh an overall effect on the pigmentary system results in deposition of pigment mainly in dermal melanophages (Albertini & Walthard 1927, Odel et al 1937, Dixon 1938, Trueblood 1947, Albeaux-Femet et al 1949, Ritz 1949, Fitzpatriek et al 1954, Moller 1954, Goodall et al 1961, Silberberg et al 1968, Sohn et al 1969, Kint et al 1973, Holcomb et al 1975, Bork et al 1977. The interesting case deseribed by Konrad & Wolff in 1974 appears to be distinct from either of the above categories in that the dissemination of melanoma cells was extensive but did not merely involve multiple nodules.…”

Localized Melanosis in an Immunocompromised Patient with Local Metastatic Melanoma

“…Several previous studies have addressed the possible pathogenesis of melanosis. 12,13,18,23,25,27,[32][33][34]36 Based on this case, we suggest that the melanoma cells contributed to the excess pigment seen in the dermis, resulting in melanosis. They hypothesized that conversion to melanin in histiocytes or in the extracellular fluid occurs via enzymes not normally associated with the later stages of melanin production.…”

“…1 Typically, generalized melanosis is a late complication of metastatic melanoma and presents as widespread cutaneous and internal organ pigment deposition. 12,13,18,23,25,27,[32][33][34] Most authors agree that a combination of these mechanisms may be responsible for the clinical finding of melanosis; however, only a few have observed metastatic cells within a biopsy specimen of the pigmented area. This leads to progressive pigmentation of all internal organs and the skin.…”

Vulvar melanoma: diffuse melanosis and metastasis to the placenta

“…The 2 previously reported cases of placental metastasis with generalized melanosis of the mother reported death of the mothers shortly after delivery, 42 and 18 days, respectively. [21][22][23] Follow-up of the first infant revealed no evidence of disease for at least 47 days, whereas the second infant presented with a slategray hue at birth. Biopsy specimen of the infant's skin produced normal findings, and by 11 months the unusual pigmentation had faded completely.…”