PMC5726680_01
Diffuse gray-blue color of the skin, predominantly on photo-exposed
areas
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A 64-year-old man, farmer, Fitzpatrick phototype I, presented with diffuse gray-blue coloration of the skin, with a cephalocaudal progression over the past three months (Figure 1).
Melanuria
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There was also history of weight loss (7Kg) in seven months, dyspnea, cough and dark urine (Figure 2).
Chest and abdomen computed tomography. A and B: Multiple
nodules in the lungs and a mass in the left inferior lobe. C and
D: Multiple nodules in the liver
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Chest radiography and chest and abdomen computed tomography were performed, that showed multiple nodular images in the lungs and liver (Figure 3).
Skin histopathology. A: Perivascular and interstitial
melanocytes in the dermis (Hematoxylin & eosin, X40).
B: Interstitial melanophages in the deep dermis,
adjacent to subcutaneous tissue (Hematoxylin & eosin, X40)
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A skin biopsy was performed in the area of hyperpigmentation on the face, and histopathology showed perivascular melanocytes in the superficial and deep dermis, and liver biopsy showed melanoma metastases (Figures 4 and 5).
Liver histopathology. A and B: Cells of metastatic melanoma
among hepatocytes and melanin in the liver sinusoids (Hematoxylin &
eosin, X40)
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A skin biopsy was performed in the area of hyperpigmentation on the face, and histopathology showed perivascular melanocytes in the superficial and deep dermis, and liver biopsy showed melanoma metastases (Figures 4 and 5).