Acquired Hypopigmentation (Leukoderma) as a Presenting Feature of Metastatic Amelanotic Melanoma With Brain Involvement

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).