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To the Editor.—
In reply to Dr. Okun's comment, I wish to point out that a metastatic malignant melanoma to the skin from an unknown primary melanoma was considered at the time of surgery, when the tumor of the skin was excised. However, an exhaustive systematic search for another possible primary tumor in the otherwise asymptomatic patient failed to reveal any suspicious lesions in the skin or the internal organs.The brain metastases appeared as numerous, bilateral, deep seated, rounded, black nodules of different sizes that were not at all suggestive of a primary malignant melanoma.The observations of Dr. Sutton are very interesting. However, we are all aware of the problems that are presented by a metastatic tumor with an unknown primary.I believe that the available clinical data together with the histologic and autopsy findings substantiate the diagnosis of a malignant cellular blue
Hernandez F. Malignant Blue Nevus-Reply. Arch Dermatol. 1973;108(5):726-727. doi:10.1001/archderm.1973.01620260070033