Alopecia neoplastica

Description

A woman in her 60s with a history of cutaneous melanoma status post wide local excision and negative sentinel lymph node biopsy more than one decade before presented with 3 weeks of worsening memory, word finding difficulty and changes in handwriting. Her family reported peculiar behaviour such as writing letters on top of (instead of next to) one another and using a hairbrush upside down. The patient also complained of new right leg pain, paraesthesias and a mild frontal headache. Dermatological exam was notable for a 2x2 cm smooth, round nodule on the right parietal scalp, which had been present for a few months and was notable for complete loss of the overlying hair (figure 1). MRI of the brain showed greater than 10 diffusely enhancing lesions suspicious for metastatic disease, with a dominant left parietal haemorrhagic lesion measuring approximately 2.8x2.9x2.2 cm (figure 2). Associated...

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