Aggressive Nodular Malignant Melanoma

Daniel J Myers,Ethan A Hyde

doi:10.7759/cureus.16819

Abstract

A subtype of malignant melanomas, nodular melanoma often carries a poor prognosis because of local invasion and frequent distant metastasis. Here, we report a case of progressive dyspnea due to one of the largest primary melanomas in the literature to date along with management strategies and elucidate some of the reasons why patients delay seeking care.

Highlights

Cutaneous melanoma is a tumor produced by the malignant transformation of melanocytes that derive from the neural crest
The four major types of melanoma are classified according to the growth pattern, namely, superficial spreading melanoma which constitutes approximately 70% of melanomas; lentigo maligna melanoma which represents 4-10% of melanomas and is often larger than 3 cm, flat, and tan, with marked notching of the borders; acral lentiginous melanoma which constitutes 2-8% of melanomas with lesions that are brown or black and ulcerate in later stages; and nodular melanoma which accounts for approximately 15-30% of melanoma diagnoses; these tumors are typically blue-black but may lack pigment [2]
This is due to its propensity to present with greater thickness, a faster mitotic growth rate, and earlier metastasis to other vital organs than other subtypes of melanoma, which often results in a poor prognosis [3]

Summary

Introduction

Cutaneous melanoma is a tumor produced by the malignant transformation of melanocytes that derive from the neural crest. The disease usually occurs on the skin and occasionally in other areas where neural crest cells are found such as the GI tract or brain [1] It accounts for 1-3% of all malignancies and 1-2% of all cancer deaths, and its incidence is rapidly increasing worldwide due to improved diagnostics, aging population, and indoor tanning devices [1]. He appeared in respiratory distress with increased work of breathing and scattered rhonchi and wheezes throughout. On biopsy and immunohistochemical stain of the mass, nodular melanoma was confirmed with a Breslow thickness of 10.1 mm, Clark level IV, stage pT4b, mitotic rate of 3 mitoses/mm, and was positive for S100, HMB-45, MelanA, SOX-10, and PRAME, but negative for BRAFV600 with 0% expression of PD-L1 on immunohistochemistry (Figure 4). Radiation Oncology initiated radiation therapy using Cyberknife with a cumulative dose of 1,800 cGy directed at the occipital lobe metastasis, and the oncology team evaluated him for enrollment into a clinical trial

Discussion

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Disclosures

10. Grisham AD