Spontaneous Hair Repigmentation in an 80-Year-Old Man: A Case of Melanoma-Associated Hair Repigmentation and Review of the Literature

Abstract

Spontaneous hair repigmentation of physiologically white or gray hair is a rare occurrence that may be associated with melanoma in elderly individuals. We present the first case of this phenomenon in a man. A gray-haired, 80-year-old man presented to dermatology clinic with a 3-cm lock of black hair on his vertex scalp that developed over 1 year. Punch biopsies showed an increase in junctional dendritic melanocytes with rare pagetoid cells and extension along the follicular outer root sheath epithelium and interfollicular epidermis, associated with prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs. Although the findings on the biopsies were not diagnostic of melanoma in situ, an irregular interfollicular distribution of melanocytes was concerning for an adjacent atypical process. A complete excision was performed and revealed melanoma in situ, lentigo maligna type. Rare reports describe spontaneous hair repigmentation as a harbinger of lentigo maligna in women. Repigmentation can occur in the setting of proliferation of malignant pigment-producing melanocytes or by paracrine stimulation of benign bulbar melanocytes through receptor tyrosine kinase KIT activation. Presence of prominent dendritic melanocytic hyperplasia and pigment-containing melanocytes within the hair bulbs in our patient's biopsies was suggestive of paracrine or physiologic stimulation of bulbar melanocytes. Given the importance of early melanoma detection and the low visibility of the scalp, this report raises awareness of an extraordinary presentation of lentigo maligna and exemplifies the importance of close clinicopathologic correlation to ensure optimal clinical management and patient outcome.

Localized grey hair repigmentation (canities reversal) in patients with frontal fibrosing alopecia

“…bulge non-active melanocytes may allow for grey/white hair repigmentation (canities reversal) under certain conditions. 1 It may occur either spontaneously, 2 in tumoral (lentigo maligna 3 ) or inflammatory conditions (porphyria cutanea tarda 4 ), or due to medications including retinoids and prednisone. [5][6][7][8] We hereby report a localized grey/white hair repigmentation case series in seven female patients with frontal fibrosing alopecia (FFA; Figs 1 and 2).…”

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

“…Repigmentation of previous white or gray hair may rise suspicion towards the possibility of LM in the scalp, and it has been described as an early sign of LM. 27 Because of this slow growth and sometimes hypomelanotic presentation, it is not uncommon that LM/LMM diagnosis is delayed, with 48.8% of lesions being >10mm in diameter at the time of biopsy. 23 With time, LM may evolve into papules, nodules or thick plaques which correspond to invasive foci thus becoming LMM and conferring risk of metastatic disease (Figure 1).…”

Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review

“…The early sign of LM has been described as repigmentation of previously white or gray hair, and it may raise suspicion that LM in the scalp is a possibility [ 10 ]. Stolz et al [ 11 ] were the first to characterize dermoscopic patterns unique to facial LMM.…”