Malignant Melanoma: An Example of the American Flag Sign

A previously asymptomatic, large black plaque on a 65-year-old man's scalp recently began to bleed. The lesion had grown considerably since it first appeared as a small black macule 3 years earlier.

A clinical diagnosis of malignant melanoma was confirmed by an incisional biopsy. An excisional biopsy of the 3.85-mm thick cancer was performed several days later. The patient refused biopsy of clinically palpable lymph nodes in his neck.

Common sites of melanoma metastases include the nodes, lungs, liver, brain, and bone. This patient died 8 months later with metastases to his brain.