An 84 year old man with a history of metastatic melanoma of the scalp who was undergoing immunotherapy presented with new, multiple blue gray macules on the scalp. A Variety of Appearances of Malignant Melanoma in the Head: A ReviewRadioGraphics Metastatic melanoma After the immune system destroys melanoma tumors, visible melanin can be left behind. We tracked tumoral melanosis in a case series of patients on immunotherapy and offer suggestions for how to monitor Frontiers Decoding Melanoma Development and Progression: Identification of Therapeutic Vulnerabilities