Metastatic melanoma of unknown primary: an unusual dermatologic presentation.

Metastatic melanoma without an identifiable primary lesion presents a unique diagnostic challenge and raises consideration of immune-mediated regression or non-cutaneous tumour origin. We describe the case of a man in his 80s diagnosed with metastatic melanoma, for whom a thorough skin examination and staging workup revealed no definitive primary lesion. Dermatologic evaluation revealed vitiligo-like depigmentation and a grey macule with clinical features suggestive of regression. While a definitive primary site could not be established, the constellation of clinical and dermatologic findings raises consideration of melanoma-associated depigmentation, an immune phenomenon in which both melanocytes and melanoma cells are targeted. This case highlights how immune-mediated mechanisms may obscure the detection of a primary lesion. Recognition of this pattern may aid in evaluating atypical presentations and contribute to the broader understanding of immune involvement in melanoma progression.

Duke Scholars

Author Elizabeth Louise Boswell Pathology

Author Michelle Bernadette Pavlis Dermatology