Giant melanoma of the scalp--discussion of a rare clinical presentation.

An 84-year-old woman presented with ulcerated scalp lesions that had been mistreated as acute haemorrhagic eczema for several months. Examination showed confluent purple-blue-grey macules, papules and nodules covering a great portion of the parietofrontotemporal scalp with focal areas of ulceration. Dermatopathologic examination of two 5 mm punch biopsies confirmed an invasive malignant melanoma (Breslow thickness of 5 mm, clark level V). In addition, lymphangiosis melanomatosa, intravascular tumour growth and a diffuse infiltration of the subcutaneous tissue were seen. Possible treatment options (eg, surgery, irradiation, intralesional treatment) were discussed with the patient, but declined. It is important that clinicians are aware that melanomas may be large and biopsies are mandatory to avoid delayed diagnosis. Thus, a dermatologist has a pre-eminent position in diagnostic procedure.