Clinical Review Lesson of the week

Zosteriform metastasis from melanoma

BMJ 2003; 326 doi: (Published 10 May 2003) Cite this as: BMJ 2003;326:1025
  1. A V Evans, locum consultant (,
  2. F J Child, consultant dermatologistb,
  3. R Russell-Jones, consultant dermatologista
  1. a Skin Tumour Unit, St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH
  2. b St Mary's Hospital, London W2 1NY
  1. Correspondence to: A V Evans

    Approximately 10% of metastases from all primary neoplasms involve the skin, but for malignant melanoma the figure is 44%.1 In some cases of melanoma this is the presenting feature, either because the primary lesion has regressed completely or because it has been unnoticed or ignored by the patient. Occasionally the melanoma has originated at an extracutaneous site such as the retina or the anal canal.

    Metastases from cutaneous melanoma normally present as flesh coloured papules or nodules in the skin. Only about a third are pigmented or ulcerated. We report a case in which cutaneous metastases from a melanoma imitated herpes zoster. This presentation is known as zosteriform metastasis; it also occurs with other neoplasms.

    Case report

    A 73 year old white man presented with a three week history of painful, pruritic vesicles on a background of erythema on the right frontal area of the scalp (figure). The lesion had not responded to self …

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