Metastases of malignant melanoma on the skin of the abdomen and thorax imitating herpes zoster

A 77-year-old male patient presented with a dark-brown nodular lesion, which grew within an oval melanocytic nevus 6×4 cm in size located on the skin of the lower abdomen. The nodule appeared 6 months earlier and had reached 2 cm in diameter. The growing cutaneous lesion manifested as a bleeding crusty sore. The nevus was completely excised together with the nodule. Histopathology revealed the nodular type of amelanotic melanoma which was ulcerated and classified as Clark II, Breslow IV (5 mm of infiltration thickness). No clear margins were noted neither vertically nor horizontally and the infiltration of the tumor encompassed the border and subcutaneous tissue. Additionally, some satellite metastases were detected subcutaneously. Most laboratory tests were within the normal range; only the erythrocyte sedimentation rate (ESR) was elevated (70–90 mm/h). There was no increase in concentrations of tumor markers (CEA, Ca125, total-PSA) and diagnostic imaging (chest X-ray, abdominal ultrasound, head CT) detected no abnormalities. At one month after the surgical excision of the primary lesion, a fine needle aspiration of inguinal lymph nodes was performed bilaterally. Subsequently, metastases of the melanoma were detected in the left groin. Palliative radiotherapy of the skin of the abdomen and chest was initiated on an outpatient basis, but the therapy was ceased at a dose of 14 Gy, before the target dose of 20 Gy, because of sudden worsening of the general health of the patient. Simultaneously, multiple, non-painful, brown papules started to occur on the skin of the left side of the chest that were interpreted as herpes zoster. Hence, the patient was given aciclovir 800 mg orally 4 times daily for the following 2 months. As there was no clinical improvement of the cutaneous lesions and new ones started to spread over the left side of the chest, the patient was again admitted to the dermatology clinic. A skin biopsy of these spreading lesions revealed melanoma metastases. The patient was given external treatment and additionally, was referred for a CT scan of the chest and abdomen. The patient died two weeks later due to the cardiorespiratory failure, so there was no chance to complete the diagnostic plan