M. D. Howard1,2, F. Bruscino-Raiola1,3, V. J. Mar1, C. A. McLean1,4, Y. Pan1, J. W. Kelly1
Poliosis is a localized patch of depigmented grey or white hair. It may be caused by drugs, systemic conditions or as an immune mediated response to melanoma and even naevi. We describe an unusual presentation of new onset poliosis developing in 76 year old man surrounding two new blue pigmented lesions on the vertex of scalp that had initially been elevated. Initial punch biopsies of both lesions demonstrated pigment incontinence, macrophages without presence of melanocytes. An excisional biopsy was recommended for deﬁnitive histopathology which showed similar changes raising the suspicion for regressed mela- noma. Wide local excision was recommended with resul- tant histopathology demonstrating in situ melanoma. This case highlights that regressed melanoma needs to be con- sidered as a differential diagnosis in individuals presenting with poliosis and suspicious features such as pigmented lesions. Multiple biopsies or wider excision may be required to reach a diagnosis and provide appropriate treatment.