Diagnosis: Melanoma metastasis to LN
Melanoma metastasis to the LN. This 6.5-centimeter mass was removed from the axilla of a middle-aged woman, who was a longtime resident of a developmental center for the severely disabled. She was unable to give any history, but there was no medical record of a primary melanoma, and we were unable to find any biopsy scars at the time of surgery. The dark brown color of the cut surface provided a clue to the diagnosis, an unusual finding in metastatic melanomas, which are more typically am
Melanoma metastasis to the LN. This 6.5-centimeter mass was removed from the axilla of a middle-aged woman, who was a longtime resident of a developmental center for the severely disabled. She was unable to give any history, but there was no medical record of a primary melanoma, and we were unable to find any biopsy scars at the time of surgery. The dark brown color of the cut surface provided a clue to the diagnosis, an unusual finding in metastatic melanomas, which are more typically amelanotic (like the upper right segment of this specimen). Pigment was easily demonstrated in the tumor cells at frozen section, allowing a definitive diagnosis intraoperatively. Photo taken by Dr. Ed Uthman.
Submitted by dermRounds Dermatology Network. Originally posted June 21, 2008.
See case discussion.
• Dysplastic (atypical) nevus • Seborrheic keratosis • Blue nevus • Pigmented basal cell carcinoma • Pigmented dermatofibroma • Thrombosed hemangioma • Solar lentigo
• ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving • "Ugly duckling sign" — the lesion that looks different from the patient's other moles • Breslow thickness is the single most important prognostic factor • Sentinel lymph node biopsy recommended for lesions ≥0.8mm or with ulceration • Subtypes: superficial spreading (most common), nodular, lentigo maligna, acral lentiginous • Acral lentiginous melanoma: most common type in dark-skinned individuals — check palms, soles, nails • Hutchinson sign in subungual melanoma: pigment extending to nail fold • Immunotherapy (anti-PD-1, anti-CTLA-4) and targeted therapy (BRAF/MEK inhibitors) revolutionized treatment of advanced melanoma
Tags: melanoma, metastasis, dermrounds dermatology network