LAUSR

An 82-year-old immunocompetent man showed up in the Sant’Orsola Hospital Dermatology Unit with hemorrhagic and crusted lesions located on his head. The skin lesions had been present for 5 weeks and were rapidly growing. Upon physical examination, disseminated hemorrhagic crusted lesions were observed on the scalp (Fig. 1). The patient had a personal history of melanoma of the vertex with Breslow thickness (BT) of 3.0 mm, excised 2 years before. He had undergone surgical enlargement, fixed with grafting; sentinel lymph node biopsy of the neck nodes had resulted negative. During the 2 years of follow-up, there had been no clinical or instrumental evidence of recurrence. A skin biopsy was performed at the edge of a crusted lesion of the lateral cervical region, and histopathological examination revealed in-transit metastases (Fig. 2). Instrumental insights displayed multiple internal organ metastases, surprisingly without