Clinical characteristics of organophosphate-induced delayed polyneuropathy.

made in our patient because of the presence of highly characteristic melanin deposits in the MRI study. This is the only method to diagnose CNS melanosis in a living patient. Secondly, in our patient there were no clinical indicators suggestive of a developing cutaneous melanoma, viz. changes in colour, size, shape, rapid growth rate, proliferative nodules or ulceration, in any of the GCMN. Hence doing a skin biopsy to rule out a developing cutaneous melanoma was not indicated. We would like to mention that malignant transformation within GCMNs is exceptionally rare in the neonate and has been reported in only three neonates. This recent review has stated that even if clinical indicators of cutaneous melanoma are present, careful histological evaluation may eventually reveal the lesion to be benign. Also, the melanin deposits detected in our patient’s MRI did not reveal any perilesional edema or necrosis or enhancement with gadolinium contrast; ruling out malignant degeneration. Thirdly, the presence of melanin deposits in our patient’s amygdala and thalami is not ‘strange’. A recent report has stated that the most common area of involvement in their case series was the amygdala; detected in eight out of 10 MRIs. Also presence of melanin deposits in thalami in cases of neurocutaneous melanosis is common.