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      A 76-year-old man was admitted to the hospital due to an increasing generalized weakness. Several weeks earlier, the patient developed a progressive gray-blue discoloration of the skin. Because of the pronounced change in skin color, this white patient was no longer recognizable on his identity card.

      A malignant melanoma that was negative for the BRAF mutation had been diagnosed 14 months earlier, and multiple metastases of the liver and spleen had been detected 5 months more previously. He had received four cycles of dacarbazine after the detection of the metastases.

      The remarkable hyperpigmentation on the skin was a result of Diffuse Melanosis Cutis (DMC). Melanosis cutis is considered to be a worrying sign and is associated with a median survival of 6 months.

      After the development of melanosis cutis, the patient lived for 16 months more, perhaps as a result of immunotherapy with ipilimumab.

      About Diffuse Melanosis Cutis (DMC)

      Diffuse melanosis cutis (DMC) is an extremely rare and late complication of metastatic melanoma (MM). It involves the progressive blue-grey discoloration of the skin and mucous membranes, occurring approximately one year after the diagnosis of MM.

      The pathogenesis of DMC is unknown, although specific growth factors, such as alpha-melanocyte-stimulating hormone, hepatocyte growth factor, and endothelin-1, released by cancer cells, along with the release of melanin precursors in the bloodstream and dermal MM micrometastases producing melanin have been attributed. https://wcts.app/WVKc

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