CASE HISTORY

Patient had had a pigmented mole on the right posterior axillary fold since birth. In 1941 it began to enlarge and occasionally bleed, but in Jun 1950 it became ulcerated and the patient, attending for a duodenal ulcer, consulted the surgeon there. 16.6.50: tumour excised 11.7.50: gastro-enterostomy for pyloric stenosis. No sign of recurrence. In November 1950: swelling in right axilla and dark spots around old scar. 22.11.50: biopsy of right axillary node. 28.11.50: block dissection of right axilla 26.1.51: patient readmitted with multiple skin deposits. Transferred here on 31.1.51 for treatment with radioactive isotopes. General condition poor. Scar in right axilla with many nodules around it. Palpable glands in left axilla. Upper right paramedian scar in abdomen with metastatic nodules around it. X- ray of chest showed widespread pulmonary metastases and old calcareous lesions at right apex. Patient subsequently developed diarrhea and later became rather confused. It was hoped to treat him by radioactive phosphorus but this was not available at the time of admission and within two weeks his general condition was much too poor for any treatment. He became steadily more weak and irrational and died on 20.2.51.

PATHOLOGY

The specimen consists of the upper half of the cerebrum. Scattered through it are innumerable deposits of melanoma. Many are near the surface and can clearly be seen through the meninges. Note the remarkable variability in the amount of melanin present in individual tumours, some being heavily pigmented and others almost white.

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