Abstract
IntroductionA melanoma can originate at the subcutis without any visible skin lesion.Case presentationA 73-year old patient came to the outpatient clinic with a subcutaneous nodule on the right thigh without any visible lesion of the skin. It turned out to be a primary subcutaneous melanoma that could be classified as a primary dermal melanoma (PDM).DiscussionA PDM is a very rare subtype of melanoma that stands out for its excellent prognosis in comparison to cutaneous melanomas. No valid reliable staging system or treatment guideline exists for this entity, Breslow depth might overestimate the clinical aggressiveness possibly leading to overtreatment.ConclusionIt is of great importance for the clinician to be familiar with a primary dermal melanoma. It deserves an appropriate place in the current AJCC system and a treatment guideline for this unique melanoma subtype with relativity excellent prognosis would be beneficial.
Highlights
A melanoma can originate at the subcutis without any visible skin lesion
We describe a case of a primary subcutaneous mela noma; a surprising entity for a subcutaneous nodule
This is a very rare subtype of cutaneous melanoma which has no epidermal compo nent but is localized to the dermis or subcutaneous tissue. This mela noma subtype is rarely reported in the literature, but stands out for its excellent prognosis in comparison to cutaneous melanomas
Summary
We describe a case of a primary subcutaneous mela noma; a surprising entity for a subcutaneous nodule. The available literature suggests a remarkably good long-term sur vival of a PDM in comparison with staged conventional cuta neous melanomas; the 5-year survival rate of PDM is 73–100% [2,4,5,6,7] against a 5–19% 5-year survival for epidermal involved melanoma with similar Breslow thickness [4,7] It is of great importance for the clinician to be familiar with the possibility a subcutaneous tumor can be a primary dermal melanoma, and it would be beneficial that this unique melanoma subtype with relatively excellent prognosis will be appointed in the current melanoma treatment guidelines and AJCC staging system. This work has been reported in line with the SCARE 2020 criteria [8]
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