{
  "abstract": "Metastatic melanoma without an identifiable primary lesion presents a unique diagnostic challenge and raises consideration of immune-mediated regression or non-cutaneous tumour origin. We describe the case of a man in his 80s diagnosed with metastatic melanoma, for whom a thorough skin examination and staging workup revealed no definitive primary lesion. Dermatologic evaluation revealed vitiligo-like depigmentation and a grey macule with clinical features suggestive of regression. While a definitive primary site could not be established, the constellation of clinical and dermatologic findings raises consideration of melanoma-associated depigmentation, an immune phenomenon in which both melanocytes and melanoma cells are targeted. This case highlights how immune-mediated mechanisms may obscure the detection of a primary lesion. Recognition of this pattern may aid in evaluating atypical presentations and contribute to the broader understanding of immune involvement in melanoma progression.",
  "authors": [
    {
      "affiliations": [
        "Dermatology, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Kali Morrissette"
    },
    {
      "affiliations": [
        "Dermatology, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Rene Chen"
    },
    {
      "affiliations": [
        "Durham Veterans Affairs Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Sarah Cater"
    },
    {
      "affiliations": [
        "Durham Veterans Affairs Medical Center, Durham, North Carolina, USA",
        "Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Elizabeth Boswell"
    },
    {
      "affiliations": [
        "Durham Veterans Affairs Medical Center, Durham, North Carolina, USA",
        "Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Michelle Pavlis"
    }
  ],
  "title": "Metastatic melanoma of unknown primary: an unusual dermatologic presentation",
  "uid": "6211d630-eca1-57ab-a523-b896e294fa64"
}