MALIGNANT BLUE NEVUS

A 41-year-old man presented with intermittent diplopia. Examination re vealed mild, left sixth nerve palsy. MRI scan revealed a tumor involvi ng the sphenoid sinus, clivus and cavernous sinus. Transphenoidal expl oration and biopsy of the tumor was performed, and histology demonstra ted malignant melanoma. Despite resection and radiation therapy, the p atient died nine months later. An extensive blue nevus was present on the left side of his scalp, and on surgical exploration this extended intracranially as far as was explored. The histology of the brain lesi on and the blue nevus were remarkably similar although cytologically, the brain lesion was more atypical. It was concluded that the brain le sion represented a metastasis or intracranial involvement from the blu e nevus. Malignant blue nevus has been previously reported. This case is important because it draws attention to the possibility that extens ive lesions involving the scalp may have intracranial involvement and may warrant aggressive management.