title: [Metastasized occult melanomas?].
abstract: METHODS
  We present two patients who were referred to us from other hospitals for further therapy as metastasized occult melanoma patients with extensive stage III and stage IV disease, respectively. On thorough clinical examination, we found a slightly thickened nail plate on the right thumb with barely visible pigmentation and a tiny skin-colored tumor at the proximal nail fold of a 60-year-old man. In a 60-year-old woman, we saw an anatomically almost hidden small nonpigmented tumor on the labia majora close to the posterior commissure. The patients were histologically diagnosed with an ulcerated acrolentigineous melanoma and a nodular mucosal melanoma, respectively.
  
  
  CONCLUSIONS
  With these two case reports we want to emphasize that although extensive radiographic and invasive diagnostic procedures to detect a primary in patients with suspected melanoma of unknown primary are no longer recommended by current guidelines, repeated and thorough clinical examinations can sometimes revise the diagnosis metastasized "occult" melanoma.
authors.affiliation: Klinik für Hautkrankheiten und Allergologie, HELIOS Hauttumorzentrum Erfurt, HELIOS Klinikum Erfurt GmbH, Nordhäuser Straße 74, 99869, Erfurt, Deutschland. ivonne.kellner@helios-kliniken.de.
authors.forename: I
authors.initials: I
authors.lastname: Kellner
authors.affiliation: Klinik für Hautkrankheiten und Allergologie, HELIOS Hauttumorzentrum Erfurt, HELIOS Klinikum Erfurt GmbH, Nordhäuser Straße 74, 99869, Erfurt, Deutschland.
authors.forename: R A
authors.initials: RA
authors.lastname: Herbst
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*
keywords: Basic diagnostic workup; Histology; Mucous membrane; Physical examination; Search for primary