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Primary dermal melanoma in a patient with a history of multiple malignancies: a case report with molecular characterization

Sini, Germana and Colombino, Maria and Lissia, Amelia and Maxia, Sara and Gulino, Marcello and Paliogiannis, Panagiotis and Palomba, Grazia and Palmieri, Giuseppe and Cossu, Antonio and Rubino, Corrado (2013) Primary dermal melanoma in a patient with a history of multiple malignancies: a case report with molecular characterization. Case Reports in Dermatology, Vol. 5 (2), p. 192-197. eISSN 1662-6567. Article.

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DOI: 10.1159/000354032

Abstract

Introduction: Primary dermal melanoma (PDM) is a recently described clinical entity accounting for less than 1% of all melanomas. Histologically, it is located in the dermis or subcutaneous tissue, and it shows no connections with the overlying epidermis. The differential diagnosis is principally made along with that of metastatic cutaneous melanoma.
Case Report: A 72-year-old Caucasian woman with a history of multiple cancers (metachro-nous bilateral breast cancer, meningioma, clear cell renal cell carcinoma, uterine fibromatosis and intestinal adenomatous polyposis), came to our attention with a nodular lesion on her back. After removal of the lesion, the histology report indicated malignant PDM or metastatic malignant melanoma. The clinical and instrumental evaluation of the patient did not reveal any other primary tumour, suggesting the primitive nature of the lesion. The absence of an epithelial component argued for a histological diagnosis of PDM. Subsequently, the patient underwent a wide surgical excision with sentinel node biopsy, which was positive for metastatic melanoma. Finally, the mutational status was studied in the main genes that regulate proliferation, apoptosis and cellular senescence. No pathogenetic mutations in CDKN2A, BRAF, NRAS, KRAS, cKIT, TP53 and PTEN genes were observed. This suggests that alternative pathways and low-frequency alterations may be involved.
Conclusions: The differential diagnosis between PDM and isolated metastatic melanoma depends on the negativity of imaging studies and clinical findings for other primary lesions. This distinction is important because 5-year survival rates in such cases are higher than in metastatic cases (80– 100 vs. 5–20%, respectively).

Item Type:Article
ID Code:9549
Status:Published
Refereed:Yes
Uncontrolled Keywords:Dermal melanoma, sentinel lymph node, dermis, skin cancer, skin nodules, neoplasia, tumour
Subjects:Area 06 - Scienze mediche > MED/06 Oncologia medica
Area 06 - Scienze mediche > MED/19 Chirurgia plastica
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Chirurgiche, Microchirurgiche e Mediche
002 Altri enti e centri di ricerca del Nord Sardegna > CNR-Consiglio Nazionale delle Ricerche > Istituto di chimica biomolecolare, Sassari
Publisher:S. Karger AG
eISSN:1662-6567
Deposited On:16 Dec 2013 16:39

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