Polypoid Melanoma: Diagnostic Hardships Concerning A Rare Melanoma Variant

Abstract

Skin cancer is the most common cancer in the United States, with a disproportionate amount of cases diagnosed as basal and squamous cell carcinoma. While melanoma accounts for only a small fraction of all skin cancers, it has greater potential for invasion and metastasis if not identified and treated early. Within this higher mortality subtype of skin cancer, there is a rare variant called polypoid melanoma (PM) that compounds the diagnostic hardships of distinguishing melanomas from more benign lesions. This aggressive melanoma has a wide variety of clinical presentations that can range from an amelanotic, sessile papule to a pedunculated, melanotic nodule. Its growth pattern also contributes to the lesion’s ambiguity, generally undergoing a slow development period that can spontaneously transition into rapid growth. This can present challenges for all potential parties involved, including the patient, primary physicians, and dermatologists alike. Such characteristics can act as barriers in clinically determining the urgency of a biopsy, thereby affecting time to diagnosis and prognosis of their patients. We report one such case of protracted diagnosis of polypoid amelanotic melanoma due to a combination of aesthetic ambiguity and lack of patient proactivity.