Metastatic melanoma in the marrow: a black and whitediagnosis

A 62-year-old man presented with a 6-month history of

progressive lethargy, generalized aches and pains, profuse

sweats and weight loss. Prednisone, given for a presumed

diagnosis of polymyalgia rheumatica, provided transient

symptomatic relief. He had a past history of left ocular

melanoma 16 years previously, treated with brachytherapy

only, following which he suffered complete blindness in his left

eye.

A blood count showed moderate anaemia and thrombocy-

topenia. The blood film was leucoerythroblastic. A bone

marrow biopsy specimen was macroscopically strongly sug-

gestive of metastatic melanoma (top). Trephine biopsy histol-

ogy (bottom) showed extensive infiltration with melanoma

cells, with melanotic and amelanotic areas. The melanotic areas

corresponded to the black area macroscopically. A computed

tomography scan showed multiple pulmonary, hepatic and

peritoneal metastases. The patient is being treated palliatively.

Bone marrow metastasis is generally associated with a

macroscopically pale trephine but the black appearance in this

case led to the suspicion of melanoma metastasis.

Sandeep Bhandari1

Fergus Jack1

Kudair Hussain2

Andrew Bell1

Departments of 1Haematology and 2Histopathology, Poole Hospital NHS

Foundation Trust, Poole, Dorset, UK.

E-mail: sanbhar@hotmail.com

images in haematology

First published online 9 March 2009ª 2009 Blackwell Publishing Ltd, British Journal of Haematology, 147, 1 doi:10.1111/j.1365-2141.2009.07620.x