FULMINANT METASTATIC MELANOMA COMPLICATED BY A MICROANGIOPATHIC HEMOLYTIC-ANEMIA

A 34-year-old male acutely presented with widely disseminated malignan t melanoma, a microangiopathic hemolytic anemia, and disseminated intr avascular coagulation Although the patient had a history of incense ch ildhood exposure to ultraviolet light and an occupational exposure to organic dyes, he had no history of a precursor skin lesion. The histop athology of the patient's bone marrow revealed sheets of malignant cel ls immunoreactive with S-100, HMB-45, and vimentin and also staining p ositively for melanin. A bone marrow aspirate revealed myeloid precurs ors filled with melanin-bearing vacuoles. Immunophenotypic analysis of the patient's bone marrow by flow cytometry revealed a paucity of hem atopoietic cells. A karyotypic analysis of the patient's tumor cells d emonstrated an abnormal hypertriploid composite clone characterized by multiple numerical and structural abnormalities. Although the patient was treated aggressively with transfusional support, heparin, and che motherapy, he expired 3 weeks after diagnosis. This is the first recog nized case of metastatic melanoma occurring in association with a micr oangiopathic hemolytic anemia.