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Journal of the American Academy of Dermatology
Volume 68, n° 3
pages 482-488 (mars 2013)
Doi : 10.1016/j.jaad.2012.08.018
Reviews

Diffuse melanosis cutis: A systematic review of the literature
 

Deshan F. Sebaratnam, MBBS (Hons) a, Supriya S. Venugopal, MBBS, MMed a, d, John W. Frew, MBBS (Hons), MMed a, James R. McMillan, PhD, MSc, BSc b, Eve R. Finkelstein, MBBS, FACD c, Linda K. Martin, MBBS (Hons), MMed a, Dédée F. Murrell, MA, BMBCh, MD, FACD a, d,
a Department of Dermatology, St. George Hospital, Sydney, Australia 
b Centre for Children’s Burns and Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Australia 
c Meuchedet Health Services, Bet Shemesh, Israel 
d University of New South Wales, Sydney, Australia 

Correspondence to: Dédée F. Murrell, MA, BMBCh, MD, FACD, Department of Dermatology, St. George Hospital, University of New South Wales, Gray St. Kogarah, NSW 2217, Australia.
Abstract
Background

Diffuse melanosis cutis (DMC) is a rare presentation of metastatic melanoma characterized by a progressive blue-gray discoloration of the skin and mucous membranes.

Objective

To foster a better understanding of the clinical presentation, histological findings, and pathophysiology underlying DMC.

Methods

A systematic review of the literature was completed utilizing MEDLINE, CINAHL, Embase, and Google. Data were extracted using a protocol-driven spread sheet with all statistical analyses completed using SPSS.

Results

The review identified 68 original cases of DMC. The mean time from diagnosis of melanoma until development of DMC was 11.48 months (95% confidence interval [CI]: 0-48.16). The mean time to death following the onset of DMC was 4.43 months (95% CI: 0.00-11.11). Histological findings were relatively consistent demonstrating intracellular and extracellular melanin deposition in the dermis, with a pronounced perivascular distribution. The pathophysiological mechanisms underlying DMC could not be definitively elucidated; however, it is hypothesized that the melanin precursors, melanin, and melanosomes liberated by cytolytic metastatic melanoma deposits are phagocytosed by dermal histiocytes, manifesting clinically as diffuse melanosis.

Limitations

The cross-sectional nature of case reports, paucity of cases of DMC, and heterogeneity in reporting limit any conclusions being drawn regarding the pathophysiology of DMC definitively.

Conclusion

DMC heralds a poor prognosis for patients with metastatic melanoma and affected patients should be made aware of the implications of this condition on survival.

The full text of this article is available in PDF format.

Key words : diffuse melanosis cutis, malignant melanoma, melanodermia, melanosis, melanuria, paraneoplastic syndromes



 Funding sources: All funding was provided by Premier Dermatology Clinical Trials, Kogarah, Sydney.
 Conflicts of interest: None declared.
Reprints not available from the authors.



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