Images in clinical medicine. Vitiligo and cutaneous melanoma

A 58-year-old woman presented with white facial patches that had progressively increased in size during a period of several months. She had no other illnesses. Physical examination revealed hypopigmented macules that were symmetrically distributed on the face and the trunk.

These lesions became more evident after examination with Wood's light and were consistent with vitiligo. The examination was otherwise notable for a gray lesion, about 2 cm in diameter, on the right leg that was associated with inguinal adenopathy. Although the patient was uncertain about the onset of this lesion, she thought it had become progressively lighter in color and less apparent during the previous 2 years. Pathological analysis revealed a melanoma in regression with lymphatic metastasis.

The development of vitiligo in the context of melanoma may be the result of an immunologic response against melanocytes. Despite surgical resection and chemotherapy, the patient died from complications of metastatic melanoma 18 months later.

CITATION  N Engl J Med. 2008 Jul 17;359(3):e3