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VIGNETTES
Rapid Enlargement of a Malignant Melanoma in a Child With Vitiligo Vulgaris After Application of Topical Tacrolimus
Maryann Mikhail, MD;
Jedd Wolchok, MD, PhD;
Stacie M. Goldberg, MD;
Ira J. Dunkel, MD;
Daniel F. Roses, MD;
Nanette B. Silverberg, MD
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Report of a Case
A 12-year-old girl presented with a 2-month history of symmetrical, depigmented patches. Her family history was remarkable only for a father with vitiligo. Before our evaluation, the patient's pediatrician had prescribed a 4-week course of tacrolimus ointment, 0.1% (twice-daily applications). The patient had been applying the medication to the depigmented areas and to a lesion on her right forearm, which was described by her father (a physician) as a 4-mm brown papule that had been stable in size and appearance for 6 months before treatment. After the tacrolimus, 0.1%, therapy was initiated, the lesion enlarged rapidly and began to bleed. The patient was otherwise in good health and had no constitutional symptoms. On examination, she had type IV skin, with depigmented patches in the periocular, perioral, chest . . . [Full Text of this Article]
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