A 41-year-old white female with a past medical history of
hypothyroidism and
alopecia universalis presented on January 24, 2002 with a recently changing mole. She indicated changes in size and color of the superior aspect of a mole that had been present for more than 8 years. She had approximately 20 lifetime peeling
sunburns due to being a lifeguard. No family or previous personal history of
skin cancers, including
melanoma or atypical
nevi, was reported. Her history of
alopecia universalis began 12 years previously and has partially resolved with remaining
patchy alopecia of the scalp and eyebrows. On diagnosis of
alopecia universalis, she was initially treated with oral
prednisone for 1 year and topical
minoxidil for 3 months. Currently, she is not being treated for this condition. She denied other previous skin conditions. She had a surgical history of
tonsillectomy at the age of 7 years. Her current medication includes
levothyroxine (0.015 microg) for
hypothyroidism diagnosed 12 years previously. She reported no known
drug allergies. During the initial physical examination, she presented with phototype II skin with two adjacent pigmented lesions on her left foot within a 1.3 cm square. The first lesion on the left posterior distal heel was an irregular, brown-black, 0.5 x 0.6 cm macule. The second lesion, on the left posterior proximal heel, was an irregular, brown, speckled, 0.3 x 0.4 cm macule (Fig. 1). The patient had ophiasis of the scalp and total
alopecia of the bilateral eyebrows. In keeping with the patient's wishes,
alopecia lesions were not biopsied and clinical photographs of the
alopecia are not included in this article. Two 3 mm punch biopsies were performed within each lesion. The left posterior proximal lesion showed
malignant melanoma, with a Breslow depth of 0.4 mm, anatomic level II, marked lymphocytic response and partial regression (Fig. 2). The left posterior distal lesion showed
malignant melanoma in situ, arising in a lentiginous compound
nevus, with architectural disorder and cytological atypia. These two lesions were concluded to be one lesion with clinical regression. She underwent local excision with 1-cm margins and sentinel lymph node biopsy owing to the presence of regression, which showed no evidence of metastatic
melanoma.
Lactate dehydrogenase and chest X-ray were within normal limits. The
alopecia areas were not biopsied previously or at that time.