Achromic Melanoma Research Articles

Amelanotic Malignant Mucosal Melanoma of the Nasal Cavity: Case Report and Literature Review

Sinonasal malignant melanoma is a rare but aggressive tumor of the head and neck area. It has a poor prognosis. Common symptoms are nasal obstruction, epistaxis, or purulent rhinorrhea. Diagnosis relies on histopathology with immunohistochemistry (IHC) studies. Surgery is the essential treatment, most often supplemented by radiotherapy or immunotherapy. A 63-year-old female patient, with a history of right dacryocystorhinostomy and Parkinson's disease, consulted for symptoms of right nasal obstruction with increasing intensity accompanied by two episodes of mild unilateral epistaxis. Rigid optic examination showed a white-pinkish right obstructive supra-centimetric endonasal tumor. CT revealed an extensive tissue process of the right nasal cavity invading the maxillary sinus, the inferior and middle conchas. A biopsy of the lesion was conducted under local anesthesia. The immunohistochemical study has shown undifferentiated tumor with positive antibody anti PS100 and anti-melan A evoking malignant sinonasal melanoma. The patient underwent two surgeries for maxillectomies as she presented a first local recurrence. She was started on adjuvant radiotherapy. At one year of follow-up, she does not present any local or general signs of disease. Sinonasal melanoma is a particular entity of head and neck mucosal melanomas. The highest incidence is described to be in the seventh and eighth decades of life with no sex difference. IHC profiling of different melanoma subtypes showed the importance of alterations in the KIT gene, this genetic data may constitute a therapeutic target. After surgery, the important local recurrence rates and regional failure justify adjuvant radiotherapy also for resections in free margins. Most authors consider that prophylactic neck dissection is not necessary. Preoperative imaging features (CT scan) are characteristic and helpful for diagnosis. IHC is essential, has a high sensitivity for differentiating achromic melanomas from other neoplasms. Sinonasal achromic melanoma is a very uncommon tumor, invasive, and frequently associated with distant metastasis. Paraclinic examinations are essential for staging and guiding therapeutic management. Immunotherapy is a promising ground of research as it comes to metastatic and advanced disease.

Atypical Ulcer Arising on Stasis Dermatitis: Achromic Melanoma

Due to venous insufficiency, a vascular ulcer frequently occurs with the progression of stasis dermatitis. Achromic melanoma, a rare form of pigmentless melanoma frequently located on the sole of the foot, is often and easily confused with a typical wound. Diagnosis of ulcerated achromic melanoma is thus often delayed and associated with a poor prognosis. The authors report a very rare case of malignant melanoma in a 70-year-old female with stasis dermatitis. The painless ulcer was present for 1 year before the first visit. Upon clinical examination, a 2-cm diameter hypergranulating ulcer with irregular and pigmented borders was present. Dermoscopy revealed the presence of red globules, a gray-to-blue veil, irregular vessels, and the remains of a pigmented ridge pattern. Histological analysis showed infiltration of atypical melanocytes in the dermis, 2 mitoses, and ulceration. Diagnosis of melanoma was confirmed by positive MART-1 immunochemistry. After removal of the melanoma, the area was covered with an autologous skin graft excised from the inner thigh. In accordance with the guidelines, sentinel lymph node biopsy was performed, and the result was negative for lymph node involvement. A comprehensive clinical dermoscopic evaluation led to the correct diagnosis. The current case highlights the importance of evaluating a chronic, atypical, nonhealing ulcer clinically and dermoscopically as well as through a biopsy procedure.

Une présentation cutanée inhabituelle de la maladie de Kaposi: un nodule plantaire solitaire

Kaposi's disease is a polyclonal tumor originating by chronic proliferations of Human Herpesvirus-8 (HHV-8) infected fusiform and endothelial cells. Endemic or african Kaposi's disease manifests in adults as angiomatous or pigmented nodules, macules or patches associated with bilateral lymphoedema of the legs and feet. We here report a case of epidemic Kaposi’s disease in an adult patient who presented with an unusual clinical manifestation of the disease: a solitary fleshy plantar nodule. The study involved a 68-year-old woman come to consultation in the department of dermatology with a painless plantar nodule, sometimes bleeding after trauma, which had evolved over the previous year. Physical examination showed a single rounded, angiomatous plantar nodule, measuring 3 cm along its longer axis, surrounded by a desquamative crown. The remainder of the physical examination was normal. Diagnostic hypotheses included eccrine poroma, botryomycoma and achromic melanoma. Complete excisional biopsy of the nodule was performed. Histological examination of the specimen showed tumor proliferation of fusiform cells associated with neocapillaries. This suggested Kaposi's disease. Immunostaining could not be performed as it was not available in our working environment. Our case is original because of an unusual clinical manifestation of epidemic Kaposi's disease, a solitary plantar nodule, that can be confused with botryomyoma and eccrine poroma.

Pyogenic granuloma under nail: A rare localization

Pyogenic granuloma (PG) – also known as lobular capillary hemangioma – is a benign vascular tumour that occurs on the skin and mucous membranes, it’s can arise spontaneously, in sites of injury, or within capillary malformations [1]. Because malignant tumors, such as amelanotic melanoma, can be misdiagnosed as PG, histopathology is mandatory for the correct diagnosis, even though dermoscopy can play a primary role in the prompt recognition of PG, showing highly repetitive patterns that can support the diagnosis [2]. In particular, the presence of reddish homogeneous area, white rail lines are strongly suggestive of PG; even more so when associated together. On the other hand, with dermoscopy, it is not uncommon to detect ulceration and vascular structures that do not rule out malignancies [3]. Vascular structures are observed in 45% of cases, they can be linear-irregular or polymorphic and atypical [2]. Despite its benign nature, GP can have a significant negative impact on patients’ quality of life, and therefore appropriate therapy is needed. This is a 35-year-old patient with a history of trauma to his left hand dating back 3 months before his admission. He presents with a nodule under his left thumb, which has been evolving for 2 months, fixed in depth and sometimes-bleeding (Fig. 1). The nodule was slightly painful. X-rays of the thumb were normal. On dermoscopy (Fig. 2), we noted the presence of vascular lagoons with fibrous septal and linear vessels. We suspected a botryomyoma or achromic melanoma. Surgical excision was performed (Fig. 3) with an anatomopathological study in favour of a pyogenic granuloma.

Breast Metastasis of a Completely Regressed Cutaneous Melanoma – Case Report and Review of Literature

Abstract Spontaneous regression of cutaneous melanoma represents a more frequent circumstance in tumors with intense MelanA immunoprofile. Melanoma-derived breast metastases are uncommon and have been predominantly reported in premenopause, as an indicator for widespread disease. We report the case of a 60-year-old female patient, who presented to the surgical department after auto-palpation of a left mammary mass. Digital mammography indicated malignant characteristics, also objectified in the ipsilateral axillary lymph nodes. The microscopical examination and immunohistochemical profile revealed left nodal and upper-outer mammary quadrant metastases of a BRAF-positive achromic melanoma. The clinical and dermoscopic evaluation confirmed the complete regression of the malignant melanocytic lesion, localised at the level of the right inframammary fold. The upper-outer breast quadrant designates the main site of primary tumors (66%), as well as metastases of other malignancies (50%), due to its well-represented vascularisation and glandular tissue. Dermoscopic characteristics of regressed melanoma comprise scar-like depigmentation and polymorphous vessels (irregular linear and globular). The particularities of this case include the age > 40 years old, survival under therapy with Vemurafenib superior to that cited in the literature (24 months to this date), the involvement of the contralateral lymph nodes in relation to the skin lesion and the inverse diagnostic approach – from pathologist to dermatologist. Completely regressed achromic melanoma, identified through diagnostic techniques performed on clinically apparent loco-regional and distant metastases, represents a rare dermato-oncological entity, with controversial implications regarding the prognosis and survival, that requires future histopathological and dermoscopic homogenization.

A small bowel metastasis from an achromic melanoma causing intussusception and bowel obstruction – a case presentation

A small bowel metastasis from an achromic melanoma causing intussusception and bowel obstruction – a case presentation

Difficulties in the diagnosis of achromic fundus lesions and hemorragic lesions

SummaryAchromic choroidal lesions can be an achromic melanoma, a choroidal hemangioma or a metastasis. It is rarer to have scleritis ar the origin of an achromic chorodal mass but this can be seen in sarcoidosis rarelyAchromic choroidal melanomas are not rare. They are often mushroom shape and have a typical ultrasonographic aspect. In the presence of an achromic melanoma, it is always important to rule out the possibility of a metastasis by doing a chest and abdominal CT.Metastasis are easy to diagnose when they occur in a patient with known metastatic disease, when they are multiple or bilateral. They are trickier when they are unique with no known previous cancer. This is quite frequent in lung cancer where the choroidal mass is often the first manifestationChoroidal hemangioma have a typical orange color and can be easily diagnosed by indocyanin green angiography (early hyper and wash out on the late phase)Hemorragic mass are frequent in older patient, especially in case of diabetes and high blood pressure. If there is a doubt MRI with gadolinium injections or dopler ultrasonography can easily differentiate a hematoma from, a choroidal tumor

Difficulties in the diagnosis of achromic and hemorragic lesions

Achromic choroidal lesions can be an achromic melanoma, a choroidal hemangioma or a metastasis.It is rarer to have scleritis ar the origin of an achromic chorodal mass but this can be seen in sarcoidosis rarely.Achromic choroidal melanomas are not rare. They are often mushroom shape and have a typical ultrasonographic aspect.In the presence of an achromic melanoma, it is always important to rule out the possibility of a metastasis by doing a chest and abdominal CT.Metastasis are easy to diagnose when they occur in a patient with known metastatic disease, when they are multiple or bilateral. They are trickier when they are unique with no known previous cancer. This is quite frequent in lung cancer where the choroidal mass is often the first manifestation Choroidal hemangioma have a typical orange color and can be easily diagnosed by indocyanin green angiography (early hyper and wash out on the late phase).Hemorragic mass are frequent in older patient, especially in case of diabetes and high blood pressure. If there is a doubt MRI with gadolinium injections or dopler ultrasonography can easily differentiate a hematoma from, a choroidal tumor.

Primary malignant achromic melanoma of the lung.

Currently, less than thirty cases of primary malignant melanoma of the lung have been reported in the literature. Thus, strict criteria for diagnosis have been published and include: malignant melanoma associated with bronchial epithelial changes; a solitary lung tumor; no prior history of skin, mucous membrane, intestinal or ocular melanoma; and absence of any other detectable tumor at the time of diagnosis. In this article we present a case of melanoma of the lung without evidence of extra-pulmonary disease.

Curie experience with transvitreal and transcleral FNAB

AbstractFine needle aspiration biopsies (FNAB) with different techniques have been recently developed during the management of intraocular tumors especially uveal melanoma. The need of a biopsy to diagnosed intraocular tumors remains rare. However in some difficult cases of achromic tumors FNAB can be helpful to distinguished achromic melanoma, metastasis, or choroidal malt lymphoma. FNAB is mainly used for choroidal melanoma prognostication. It has been shown that choroidal melanoma prognosis depends on well‐known clinical factor but also genetic factors within the tumor (monosomy 3 and 8q addition or GEP class II). Determination of patient prognosis by FNAB open the way to adjuvant chemotherapy for high risk patients. Different techniques can be used to obtain sufficient tumor samples and these different techniques will be exposed during this symposium. Curie experience using transcleral or transvitreal FNAB will be described.

Conditions mimicking scleritis

AbstractScleritis is an inflammatory process due to a huge number of inflammatory systemic etiologies and treated with corticosteroids or immunosuppressive drugs. Pseudoscleritis are represented by tumoral diseases that looks like scleritis but with a painless clinical presentation, and unresponsive to corticosteroids. Theses tumoral pathologies that may simulate scleritis are usually tumors of the conjunctiva (carcinoma, achromic melanoma, sarcoma, Malt lymphoma…) however some atypical presentation of intraocular tumors can mimic anterior or posterior scleritis. The tumoral origin of ocular pathologies must not be delayed because it increases the risk of metastasis and death. One a tumor is suspected patient should be referred to an onco ophthalmologist for diagnosis and management. In this paper, the different tumoral pathologies and their management will be described.

Nevus Spilus and Melanoma: Case Report and Review of the Literature

Nevus spilus is characterized by a pigmented patch with scattered flat or maculopapular speckles. Nevus spilus was first described by Burkley in 1842. Since then, this lesion has been widely debated in the literature, particularly for the possible occurrence of melanoma within the lesion. We describe the case of a 65-year-old female presenting with a nodular achromic melanoma that occurred within a nevus spilus on the left thigh. Our observation is consistent with the idea that this entity in some circumstances may have the ability to evolve into a malignant melanoma.