Recurrent malignant melanoma presenting with zosteriform metastases.

A 63-year-old man with recurrent metastatic malignant melanoma presented with a painful right twelfth thoracic dermatomal eruption initially thought to be herpes zoster. However, 3 weeks later, the patient clearly had melanoma skin metastases confined exclusively to this dermatome. Radiotherapy and opiate analgesics provided effective pain relief. We propose that in this patient, no herpes zoster infection occurred, but rather that skin metastases presented in a zosteriform pattern due to lymphatic spread from a previously excised paravertebral skin metastasis. This is the second reported case of malignant melanoma presenting as zosteriform metastases, and we suggest physicians consider this possibility in patients with melanoma presenting with dermatomal skin changes.