Diagnosis Of Primary Melanoma Research Articles

Ipilimumab Activity in Advanced Uveal Melanoma: A Pooled Analysis

Uveal Melanoma (UM) is a rare tumour, with an estimated annual global incidence between 5.3-10.9 cases per million people. It accounts for less than 5% of all melanoma cases. UM arises from the vascular layers of the eye (iris, ciliary body, and choroid). It is a highly aggressive malignancy and about 50% of patients will develop metastatic disease at some stage after prior diagnosis of primary uveal melanoma. Liver is the dominant site of metastases (60-90%) followed by lungs (25%).

Is the frequency of primary cutaneous melanoma increasing in Turkey? An evaluation of the experiences of two dermatology centers

Abstract Introduction and purpose Since there are only a few population-based studies about the incidence of melanoma in Turkey which do not cover the whole population, we aimed to contribute the data regarding the current situation and the changes in the frequency of primary cutaneous melanoma (PCM) diagnosis in our country by evaluating our results and comparing them with national literature from Turkey. Methods Consecutive PCM lesions diagnosed at the Dermatovenereology Departments of the Istanbul Medical Faculty (first center) between 1997 and 2016 and of the Ankara Medical Faculty (second center) between 2007 and 2016 were retrospectively reviewed. The yearly number of PCMs diagnosed in each clinic over study period were compared about any change in the frequency of melanoma diagnosis. Results There were 239 and 183 PCMs diagnosed in the two centers in twenty and ten years study period and the mean PCM diagnosis per year was 11.9 and 18.3, respectively. The number of PCM diagnosis markedly increased over time in both centers: 36, 45, 75 and 83 diagnosis for the subsequent five-year periods in the first center and 51 and 132 diagnosis for the subsequent five-year periods, in the second center. Discussion It was striking that the number of PCM diagnosis increased steadily in both dermatovenereology centers. As several large melanoma series have been reported from various disciplines all over Turkey in the last two decades and numerous of them have also drawn attention to the increasing frequency of PCM diagnosis similar to our results, supporting data about increasing incidence of melanoma diagnosis for our country have been obtained.

Primary sinonasal mucosal melanoma – Case report and literature review

Abstract BACKGROUND. Primary sinonasal mucosal melanoma is a rare tumor with a poor survival rate. There is an inherent difficulty in diagnosing these lesions, especially because their complex anatomic locations and symptoms can be frequently confused with other benign or malignant processes. The purpose of our study was to report a difficult case and review the literature and recent research on therapeutic modalities. MATERIAL AND METHODS. We herein report a 61-year-old female patient, with a history of right eye enucleation and prosthesis, who presented with obstruction of the left nostril, anterior and posterior mucopurulent rhinorrhea, anosmia, left facial numbness, left exophthalmia accompanied by ipsilateral epiphora and decreased visual acuity. RESULTS. Clinical and imagistic testing revealed a large, grayish, fleshy tumor localized in the left maxillary sinus, with extension to the left orbit (producing osteolysis of the inferior and medial orbital walls), nasopharynx, ethmoidal cells and left frontal sinus. Pathological and immunohistochemical examination confirmed the diagnosis of mucosal melanoma. Other primary sites were excluded. The patient succumbed shortly after, following only palliative treatment. CONCLUSION. Early diagnosis of primary sinonasal mucosal melanoma is essential but very difficult to detect. Any symptoms such as unilateral epistaxis or nasal obstruction in a patient over the age of 60 should be rendered suspicious. Pathological and immunohistochemical examination for diagnosis and prognostic factors are important. Although surgery is the first option for treatment, one must consider, according to tumor staging, radiotherapy and chemotherapy with immunotherapy as a viable course of treatment for advanced cases.

Understanding the Microenvironment of Melanoma Cells for the Development of Target Drug Delivery Systems

Melanoma is the most aggressive and deadly form of skin cancer. The high rate of patient death is related to advanced melanoma metastasis, which usually occurs several months to years after the primary melanoma diagnosis. At an early stage, the melanoma tumour can be removed, therefore promoting a survival rate up to 99%. In this manuscript, we elucidate the tumour microenvironment factor, which is crucial for melanoma growth, proliferation, and metastasis. Melanoma is more resistant to traditional therapies, such as chemotherapy and radiotherapy; indeed, tumour-associated macrophages are often related to the worst prognosis. A better understanding of the melanoma microenvironment, including melanoma-associated fibroblasts and hypoxia-inducible factors, will enable researchers to develop drug-delivery systems with higher anticancer activity than current melanoma therapies available on the market. This review also covers macrophage targeting melanoma, such as macrophage colony-stimulating factor receptor inhibitors, C-C chemokine ligand 2 inhibitors, and vaccines combining αFAP-PE38 and melanoma associated antigens via lentiviral vectors. We also report a study using statins, which demonstrated long circulating liposome-encapsulate simvastatin reduced tumour-associated macrophage-mediated oxidative stress and production of the hypoxia-inducible factor 1α in tumours. In melanoma, xenografts may be treated with antiangiogenic agents targeting different angiogenic pathways, such as properdistatin, which selectively removes small diameter vessels and reduces the blood supply time. Sunitinib also plays a role in reducing the density of small and large diameter vessels, although it does not change the blood supply time. Considering all these factors holistically suggests that a better understanding of the melanoma microenvironment is crucial for the development of a novel and effective therapeutic approach.

An Atypical Cause of Biliary Obstruction

The aim of this case of atypical metastatic melanoma is to highlight the need for endoscopic evaluation in any biliary obstructed patient with a diagnosis of cutaneous melanoma. A 69 year old CM with a history of HTN, CAD, and skin SCC presented with abdominal pain and N/V for two weeks. He was diagnosed with acute pancreatitis. CT scan showed an enlarged pancreatic head, enlarged hilar lymph nodes, and many subcutaneous nodules. A nodule biopsy was positive for S-100 and Melan-A indicating melanoma. He was discharged but later returned in two months with worsened abdominal pain and jaundice. His bilirubin was 20. A repeat CT showed a CBD of 14 mm. An ERCP performed showed a 3 cm ulcerated dark mass in the duodenum distal to the ampulla, a distal CBD stricture, and a one cm dark nodule in the 2nd part of the duodenum. A sphincterotomy was performed with placement of a biliary stent. Duodenal mass biopsies demonstrated metastatic melanoma. Symptom relief was achieved after the procedure but given the progression of his malignancy, the patient deceased one week later. Malignant melanoma is one of the most common cancers to metastasize to the GI tract. Post-mortem studies have identified GI metastases in 60% of disseminated melanoma patients. An autopsy study of malignant melanoma patients showed the most common sites of metastases in the GI tract were liver, small bowel, colon, stomach, and then duodenum. The extremities are the most common source for GI tract melanoma metastases. Detection of GI metastases usually varies between 21-54 months after the primary melanoma diagnosis. These metastases can be found with PET scans, CT scans, barium studies, EGD, ERCP, or colonoscopy. Stains S-100 and HMB-45 on endoscopic biopsies can help confirm the diagnosis. The prognosis of metastatic melanoma to the GI tract is poor with a median survival of 12 months and a 14% five year survival rate. Treatment options for GI melanoma metastases include surgical resection, chemotherapy, or immunotherapy. Presented here is a case of melanoma metastatic to the GI tract that is atypical in its presentation of jaundice, biliary ductal dilation, and pancreatitis due to its duodenal location. The duration of two months between the patient's initial melanoma diagnosis and detection of duodenal melanoma metastases was also unique. This case illustrates the need to endoscopically evaluate any melanoma patient who presents with abdominal symptoms or signs of biliary obstruction.Figure. 3: cm ulcerated periampullary mass.

Cardiac melanoma: Retrospective review of a rare disease at the Mayo clinic (1988–2015)

BackgroundMelanoma metastasizing to the heart (cardiac melanoma) is a rare entity that has been described only in autopsy studies or isolated pre-mortem case reports. We aim to better characterize cardiac melanoma, and describe its presenting features, imaging findings, and disease course with a case series collected over nearly 30years. MethodsWe performed a retrospective review of all patients diagnosed with cardiac melanoma at the Mayo Clinic from 1988 to 2015. Qualitative analysis was performed on patient demographics, clinical history, and imaging modalities. Results11 patients (7 male, median age 63years) were identified with cardiac melanoma. Shortness of breath (64%) was the most common presenting symptom. Transthoracic echocardiography (TTE) was utilized in the assessment of all patients though it failed to identify 20% of masses that were seen on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) or cardiac magnetic resonance (CMR). The majority of masses were located within the cardiac chambers (46% right atrium, 18% right ventricle, 18% left atrium), and 36% appeared mobile on TTE. Patients lived for a median of 68months (interquartile range [IQR] 14–143months) after the initial diagnosis of primary melanoma, and only 12months (IQR 2–150months) after diagnosis of cardiac melanoma. ConclusionEchocardiography can generally identify most cases of cardiac melanoma, though it misses one-fifth of masses seen on FDG PET/CT or CMR. Cardiac melanoma is associated with a poor prognosis.

Reduced disease‐specific survival following a diagnosis of multiple primary cutaneous malignant melanomas—a nationwide, population‐based study

Outcome data comparing patients with multiple primary invasive cutaneous malignant melanomas (MPMs) to single primary invasive cutaneous malignant melanomas (SPMs) show conflicting results. We have analyzed differences in disease-specific survival between these patients in a nationwide population-based setting. From the Swedish Melanoma Register, 27,235 patients were identified with a first invasive cutaneous malignant melanoma (CMM) between 1990 and 2007, followed-up through 2013. Of these, 700 patients developed MPMs. Cox proportional hazard regression was used for adjusted cause-specific hazard ratios (HRs). An interval of ≤5 years between CMM diagnoses was significantly correlated to a decreased CMM-specific survival in Stage I-II MPM- vs. SPM-patients (HR 1.32; 95% CI 1.04-1.67; p = 0.02). MPM-patients with longer time interval between diagnoses experienced similar risk of CMM-death as SPM-patients. The risk of CMM-death increased by almost 50% above the expected outcome according to stage of the index CMM by the diagnosis of a second CMM (HR 1.48; 95% CI 1.19-1.85; p < 0.001). MPM vs. SPM-patients had a worse outcome (HR 1.38; 95% CI 1.05-1.83; p = 0.001). This emphasizes the importance of prevention efforts in SPM-patients to decrease the risk of subsequent CMMs and has implications for more vigilant follow-up in MPM-patients.

Associations of Statins and Diabetes with Diagnosis of Ulcerated Cutaneous Melanoma

Ulcerated primary melanomas are associated with an inflammatory tumor microenvironment. We hypothesized that systemic proinflammatory states and anti-inflammatory medications are also associated with a diagnosis of ulcerated melanoma. In a cross-sectional study of 787 patients with newly diagnosed clinical stage IB or II melanoma, we estimated odds ratios for the association of proinflammatory factors (high body mass index, diabetes, cardiovascular disease, hypertension, and smoking) or the use of anti-inflammatory medications (statins, aspirin, corticosteroids, and nonsteroidal anti-inflammatory drugs), with ulcerated primary melanoma using regression models and subgroup analyses to control for melanoma thickness and mitotic rate. On the basis of information from 194 patients with ulcerated and 593 patients with nonulcerated primary melanomas, regular statin users had lower likelihood of a diagnosis of ulcerated primary melanoma (odds ratio 0.67, 95% confidence interval 0.45-0.99), and this association remained after adjusting for age, sex, thickness, and mitosis. When analysis was limited to melanomas that were ≤2 mm thick and had ≤2 mitoses/mm2 (40 ulcerated; 289 without ulceration), patients with diabetes had significantly raised odds of diagnosis of ulcerated melanoma (odds ratio 2.90, 95% confidence interval 1.07-7.90), adjusted for age, sex, body mass index, and statin use. These findings support our hypotheses that statin use is inversely associated, and diabetes is positively associated, with ulcerated melanoma.

Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries

Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits. The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person-years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar. Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.

The demand for psycho-oncological support in 820 melanoma patients: What are the determinants for the development of distress?

9514 Background: There is limited data about the impact of melanoma on the psychological burden of patients. Despite some known predictors for distress like female gender or younger age, melanoma stages have not been found being related to distress in melanoma patients and there is no data concerning distress in melanoma patients under systemic treatment for metastases. Methods: Between July and September 2016, 820 melanoma patients at the outpatient clinic at the Department of Dermatology at the University of Tuebingen underwent psycho-oncological screening. The patients routinely completed the distress thermometer (DT), supplemented by a problem list, before consulting the physician. DT scores ≥ 5 are above-threshold, indicating the need for psycho-oncological support. We matched psycho-oncological data with tumor and patient specific data to examine tumor or patient specific influence on distress using logistic regression. Results: 406 (49.5%) men and 414 (50.5%) women were included, mean age was 62.35 years (IQR 52-75), mean time since primary diagnosis of melanoma was 54.84 months (IQR 15-76). 359 (44%) of the patients suffered from advanced melanoma (stage III n = 182, stage IV n = 177). 120 patients (14.6%) received systemic treatment for metastases: 90/120 (75%) checkpoint inhibitors, 27/120 (22.5%) targeted therapy and 3/120 (2.5%) chemotherapy. 338/820 (41.2%) of the patients met the cut-off score for distress. Significant influencing factors (p &lt; 0.05) for DT values of ≥ 5 were: female gender, younger age, melanoma stage III and IV. Interestingly we found a lower risk for values above-threshold for patients under systemic treatment, although this was not significant (p = 0.252). Conclusions: This is the first analysis to demonstrate the impact of advanced melanoma stages on DT scores above-threshold. Our study is also the first to indicate a lower risk for distress in patients under systemic treatment. This might be due to the closer contact between these patients and their physicians. Nevertheless, more than 40% of our patients needed psycho-oncological support. Departments that care for melanoma patients should therefore be fitted by a sufficient number of psycho-oncologists.

Primary Malignant Gingival Melanoma: Case Report and Educational Reminder

AbstractOral melanomas are extremely rare tumours accounting for approximately 1.6% of all head and neck malignancies. They usually have a silent clinical presentation but are distinctly more aggressive than all other types of melanoma. Poor patient awareness coupled with a lack of education amongst health care professionals in recognising premalignant pigmented lesions can result in delayed patient presentation and referral to specialist services for diagnosis and treatment. We present the case of a patient who was referred to the Oral Medicine Department at Leeds Dental Institute with a hyper‐pigmented lesion affecting the maxillary gingivae. Histopathology findings confirmed a diagnosis of primary malignant gingival melanoma (Breslow stage 1). The patient sadly died less than 6 months later. This case highlights the importance of early detection, timely referral and the need for greater public awareness in order to improve prognosis of such highly invasive lesions.

Endoscopic diagnosis of primary anorectal melanoma.

ObjectiveThe present study retrospectively analyzed case data from 12 patients diagnosed with anorectal melanoma, with the purpose of identifying key diagnostic features at endoscopy.Materials and MethodsImages from colonoscopy were reviewed for all patients in order to establish the endoscopic features of primary anorectal melanoma. For the patients whose colonoscopic examinations included endoscopic ultrasound, images were examined to characterize lesions and the depth of infiltration, the results of which were compared with pathological findings after operative resection.ResultsAt colonoscopy, superficial melanin pigmentation was identified in 10 patients with anorectal melanoma, with morphology including spots, patches, or sheets of pigmentation. In patients who underwent endoscopic ultrasound, lesions appeared as masses on the mucosal side with inhomogeneous or low-level internal echoes or ulcer-type lesions invading the muscularis propria. Lesions diagnosed as anorectal melanoma also demonstrated irregular margins and varying degrees of submucosal infiltration. Infiltration depth of melanoma via endoscopic ultrasound (EUS) was concordant with surgical pathology results in 100% of patients.ConclusionColonoscopy combined with biopsy and subsequent pathological examination can accurately diagnose primary anorectal melanoma. Moreover, EUS is a reliable tool for assessing the depth of infiltration of this disease.

Selective Internal Yttrium-90 Radioembolization Therapy (90Y-SIRT) Versus Best Supportive Care in Patients With Unresectable Metastatic Melanoma to the Liver Refractory to Systemic Therapy: Safety and Efficacy Cohort Study.

To investigate survival, efficacy, and safety of selective internal yttrium-90 radioembolization therapy (Y-SIRT) in patients with unresectable metastatic melanoma (MM) to liver refractory to systemic therapy. An IRB-approved retrospective review of 58 patients diagnosed with unresectable MM to the liver, refractory to systemic therapy, between February 2003 and March 2012 was conducted. Of these, 28 received resin-based Y-SIRT (group A), and 30 patients received best supportive care (group B). Survival was calculated using the Kaplan-Meier method and Cox proportional hazard models. Groups A and B were similar for the Child-Pugh class, ECOG scores, age, sex, and race. Median overall survival (OS) from diagnosis of primary melanoma in groups A and B were 119.9 and 26.1 months, respectively (P<0.001). Median OS from hepatic metastasis in groups A and B were 19.9 and 4.8 months, respectively (P<0.0001). In group A, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 37.7, 4.2, and 3.6 months, respectively (P<0.001). In group B, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 7.8, 4.2, and 1.9 months, respectively (P=0.04). Within group A, median OS from first Y-SIRT was 10.1 months; median OS of the Child-Pugh A, B, and C patients from first Y-SIRT was 10.3, 1.2, and 0.9 months, respectively (P=0.04). Median OS from first Y-SIRT was significantly greater in the absence of diffuse (>10) liver metastases (15.1 vs. 4.7 mo, P=0.02), and in the absence of extrahepatic metastases (21.3 vs. 8.6 mo, P<0.001). Common clinical toxicities following Y-SIRT included abdominal pain (17.9%), fatigue (14.3%), and self-limiting grade III bilirubin toxicity (10.7%). For patients with unresectable MM to the liver refractory to systemic therapy, resin-based Y was associated with longer survival from liver metastases than best supportive care. Child-Pugh A patients with <10 metastatic lesions and absence of extrahepatic metastases demonstrated greatest survival following Y-SIRT.

Primary Pulmonary Malignant Melanoma: Report of an Important Entity and Literature Review

Malignant melanoma involving the respiratory tract is nearly always metastatic in origin, and primary tumors are extremely rare. Published data on primary pulmonary malignant melanomas are limited. Up to now 40 relevant cases have been reported in the English literature. Herein, we report a case of a 56-year-old female patient who presented with intracranial metastases due to primary pulmonary melanoma. She underwent bronchoscopy and died 5 months after the initial diagnosis despite the administered biochemotherapy and subsequent immunotherapy. To establish the diagnosis of primary pulmonary malignant melanoma, any extrapulmonary origin was excluded by detailed examination and radiographic imaging. Moreover, an extensive review of the literature regarding this rare entity has been performed.

Primary melanoma of the small bowel revealed by gastrointestinal bleeding: a case report

BackgroundPrimary melanoma of the small bowel is extremely rare. Only a limited number of cases have been described in the literature. Mostly, the small intestine is affected by metastatic tumors of other primary lesions, especially cutaneous.Case presentationWe report the case of a 75-year-old North African woman with a small bowel melanoma. The diagnosis was made by histological examination and immunohistochemical profile matching after a segmental small bowel resection. Postoperative investigations looking for cutaneous, gastrointestinal or ocular primary lesions found no abnormalities.ConclusionsThe diagnosis of primary small bowel melanoma can be retained although it remains difficult to exclude the possibility of metastatic melanoma.

Pediatric melanomas often mimic benign skin lesions: A retrospective study

Childhood melanoma can be misdiagnosed because of its rarity and atypical presentation. We sought to correlate the clinical appearance of pediatric melanomas with Breslow depth and clinical behavior, and to identify diagnostic errors made by dermatologists and nondermatologist physicians. This was a retrospective review of Mayo Clinic records of children and young adults 21years of age or younger with a diagnosis of primary cutaneous melanoma between January 2000 and January 2015. Pediatric melanomas that mimicked benign skin lesions were more often deeper (>1mm; odds ratio 5.48; P=.002) and had a higher T stage (odds ratio [T2, T3, or T4] 6.28; P=.001) than melanomas with a clinically malignant appearance. Of pediatric melanomas, 66% originally diagnosed as benign melanocytic lesions exhibited changes in size, shape, and color. Sample size and retrospective design are limitations. Benign-appearing pediatric skin lesions with a history of evolution, bleeding, or ulceration should raise suspicion for melanoma. Melanomas demonstrating these features are associated with a higher Breslow depth and T stage. Although biopsy of all lesions that exhibit change in children is not practical, safe, or desired, close monitoring is recommended.

Sex Differences in Age at Primary Melanoma Diagnosis in a Population-Based Analysis (US Surveillance, Epidemiology, and End Results, 2005–2011)

Sex Differences in Age at Primary Melanoma Diagnosis in a Population-Based Analysis (US Surveillance, Epidemiology, and End Results, 2005–2011)

The impact of clinical stage at primary melanoma diagnosis on post-recurrence survival.

9550Background: Time to metastatic recurrence from primary melanoma diagnosis is known to vary based on original stage at diagnosis. However, little is known on whether recurrent melanoma originati...

Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma.

Wide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future.

Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma

Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. A 61-year-old male farmer was referred for evaluation of a mass in the right supraclavicular region and a left adrenal lesion. The patient had a history of a multifocal papillary and medullary thyroid carcinoma. Laboratory tests revealed increased 24hour urinary dopamine and also increased serum calcitonin and neuron specific enolase. A pathology report of the resected right supraclavicular mass and left adrenal showed a malignant melanoma. This is a case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Although this case is very rare and there are rigid diagnostic criteria for the diagnosis of primary adrenal melanoma, it underlines the fact that the differential diagnosis of a dopamine secreting adrenal mass should include primary or metastatic malignant melanoma in order to determine the best diagnostic approach for the patient and select the most appropriate surgical management.