Melanoma of the Umbilicus: An Incidental Diagnosis During Fat-Harvesting Donor-Site Selection

Abstract

A 36-year-old white woman initially came to our department because of breast asymmetry. A unilateral breast implant and contralateral periareolar mastopexy were the selected surgical treatments. After 7 years, we had to remove the breast implant because of capsular contracture. In agreement with the patient, we decided to opt for breast lipofilling. Incision sites for abdominal fat harvesting generally are in the suprapubic region and the upper lateral abdomen. An additional entry site in the umbilicus often is selected because the scar is well hidden once completely healed, with a very satisfactory aesthetic outcome. In the operating room, with the woman under general anesthesia, we detected a pigmented lesion on her umbilical scar before fat harvesting from the abdomen. The lesion passed unnoticed during physical examination. It showed irregular margins, measured 1.2 cm in diameter, and arose on the inferior portion of her umbilical scar, extending to its bottom (Fig. 1). The patient ignored the lesion and had a negative family history for melanoma. No axillary or inguinal lymphadenopathy was present. At surgery, we preemptively changed the fat donor area to the lateral and medial regions of the thighs but did not excise the lesion due to the patient’s lack of consent. After surgery, we asked for dermatologic advice, which recommended excision of the lesion. Therefore, we excised the lesion and sent it for histologic examination. Histology showed a melanoma in situ arising in a preexisting naevus with negative margins less than 2 mm. A widened excision down to the peritoneum with superficially clear 0.5 cm margins was performed to obtain local disease control. For umbilical reconstruction, a defatted V–Y skin flap was created to preserve the umbilical aesthetic appearance. Closure of soft tissues was performed according to a standard procedure. A Moulage dressing was applied. The patient’s postoperative recovery was without complications. During a 3-month follow-up period, the patient had no evidence of local recurrence or metastases. Malignant tumors of the umbilicus account for approximately 43 % of all umbilical tumors and can be classified as primary or metastatic. Primary malignant umbilical tumors represent only 20 % of all malignancies in this area. Hence, melanoma presenting on the umbilicus is extremely rare [1, 2]. The diagnosis of umbilical melanoma frequently is determined in the late stages, possibly because the umbilicus is an area not often explored during skin cancer screening and due to delay in seeking medical advice by the patient [3]. The reported case also highlights the difficulty in the examination and follow-up evaluation of certain umbilical naevi, particularly when the lesion is partially inaccessible at clinical and dermoscopic examination. L. A. Dessy M. Maruccia A. Romanzi M. G. Onesti Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico, 155 00161 Rome, Italy