Bilateral Atrial Myxomas Associated with Hyperpigmented Skin Lesions

To the Editor: A 51-year-old white man was admitted to the hospital because of fever, weight loss, and several episodes of systemic embolization, manifested as sharp, left-sided flank pain with macrohematuria and episodes of painful purple discoloration of his fingers and toes. Seven years earlier, a pigmented nevus (0.7 by 0.4 cm) had been excised from his upper back and diagnosed as malignant melanoma, with invasion of the skin to the level of the papillary dermis (Clark level III). On examination, the patient had skin phototype 2 (i.e., skin that usually burns and sometimes tans), with various hyperpigmented cutaneous lesions, . . .