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Vitiligo-like depigmentation in patients with malignant melanoma is a poorly understood phenomenon. We report a patient who presented with a 4-month history of vitiligo-like depigmentation of the face, trunk and limbs. Physical examination revealed an enlarged left inguinal lymph node. A needle biopsy taken from the lymph nodes revealed metastatic malignant melanoma. One small nodule on the left sole was found subsequently. Despite the absence of junctional activity, it was considered to be a primary tumour with regression of the epidermal lesion. The patient died from sepsis, the main complication of immunosuppressive therapy, without evidence of distant metastasis. We report this case to highlight the importance of careful physical examination of patients with skin hypomelanoses. We also propose that, due to the favourable prognosis in patients with malignant melanomas and vitiligo-like depigmentation, the treatment plan may be more conservative to minimize the adverse effects of chemotherapy.

BACKGROUND Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures. OBJECTIVE This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection. METHODS Thirty‐six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40°C) and room‐temperature neutral (22°C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room‐temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS). RESULTS A statistically significant decrease (p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room‐temperature, neutral injection side (mean rating, 53.3 mm). Patient‐reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room‐temperature nonneutral (mean rating, 61.2 mm) was statistically significant (p < .001). CONCLUSION The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures.

Taiwan is not considered an endemic area of leishmaniasis. Imported cases are encountered infrequently, and only two cases of indigenous cutaneous leishmaniasis have been reported. 1 We found one new case in the past 20 years. The patient presented with erythematous plaques on the nasal bridge and right thumb. Skin biopsy specimens from both sites revealed numerous Leishman-Donovan bodies in macrophages. There was no history of travel outside the country, and the diagnosis of indigenous cutaneous leishmaniasis was made. Polymerase chain reactions (PCR) identified the species as Leishmania tropica . The route of infection in this patient is unclear. Because pentavalent antimony, the drug of choice for leishmaniasis, is not available in Taiwan, the patient was treated with levamisole and potassium iodide, with an excellent response.