A 57-year-old man with no relevant medical history was initially seen with clumsiness and judgment errors while driving for the past 3 weeks. His neurological examination results revealed cognitive impairment and a left homonymous hemianopsia. Skin examination findings were remarkable for multiple oval well-defined depigmented macules on the back of his hands, feet, and neck that were first noticed during the preceding months (Figure 1). On his left shoulder, there was a 1-cm round erythematous nodule (Figure 2).
Karakis I, McGeeney B, Demierre M, Thiele JJ, Wolpowitz D, Bhawan J. Acquired Hypopigmentation (Leukoderma) as a Presenting Feature of Metastatic Amelanotic Melanoma With Brain Involvement. Arch Neurol. 2007;64(12):1786-1787. doi:10.1001/archneur.64.12.1786