case_images: PMC5726680_01
case_images: Diffuse gray-blue color of the skin, predominantly on photo-exposed
  areas
case_images: abd-92-05-s1-0062-g01.jpg
case_images: PMC5726680_01_abd-92-05-s1-0062-g01.jpg
case_images: f1
case_images: A 64-year-old man, farmer, Fitzpatrick phototype I, presented with diffuse gray-blue coloration of the skin, with a cephalocaudal progression over the past three months (Figure 1).
case_images: Melanuria
case_images: abd-92-05-s1-0062-g02.jpg
case_images: PMC5726680_01_abd-92-05-s1-0062-g02.jpg
case_images: f2
case_images: There was also history of weight loss (7Kg) in seven months, dyspnea, cough and dark urine (Figure 2).
case_images: Chest and abdomen computed tomography. A and B: Multiple
  nodules in the lungs and a mass in the left inferior lobe. C and
  D: Multiple nodules in the liver
case_images: abd-92-05-s1-0062-g03.jpg
case_images: PMC5726680_01_abd-92-05-s1-0062-g03.jpg
case_images: f3
case_images: Chest radiography and chest and abdomen computed tomography were performed, that showed multiple nodular images in the lungs and liver (Figure 3).
case_images: Skin histopathology. A: Perivascular and interstitial
  melanocytes in the dermis (Hematoxylin & eosin, X40).
  B: Interstitial melanophages in the deep dermis,
  adjacent to subcutaneous tissue (Hematoxylin & eosin, X40)
case_images: abd-92-05-s1-0062-g04.jpg
case_images: PMC5726680_01_abd-92-05-s1-0062-g04.jpg
case_images: f4
case_images: A skin biopsy was performed in the area of hyperpigmentation on the face, and histopathology showed perivascular melanocytes in the superficial and deep dermis, and liver biopsy showed melanoma metastases (Figures 4 and 5).
case_images: Liver histopathology. A and B: Cells of metastatic melanoma
  among hepatocytes and melanin in the liver sinusoids (Hematoxylin &
  eosin, X40)
case_images: abd-92-05-s1-0062-g05.jpg
case_images: PMC5726680_01_abd-92-05-s1-0062-g05.jpg
case_images: f5
case_images: A skin biopsy was performed in the area of hyperpigmentation on the face, and histopathology showed perivascular melanocytes in the superficial and deep dermis, and liver biopsy showed melanoma metastases (Figures 4 and 5).