Spontaneous subcapsular and perirenal haemorrhage with retroperitoneal haematoma in a patient with ovarian melanoma metastases.

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.

Unilateral Fourth Nerve Palsy due to Presumed Metastatic Melanoma.

ABSTRACT: An 81-year-old man with a history of metastatic melanoma presented with sudden onset of painless, binocular vertical diplopia. The clinical examination was consistent with a right fourth nerve palsy. An MRI of the head revealed a mass dorsal to the right tectum at the level of the inferior colliculus. An MRI just 4 months prior did not show a lesion in that location. An MRA of the head did not show an aneurysm. This is a rare case of an isolated fourth nerve palsy believed to be due to metastatic melanoma compressing the nerve along the dorsal midbrain.

Primary Amelanotic CNS Melanoma: Case Report and Literature Review.

Primary malignant melanomas of the central nervous system (CNS) are rarely seen entities in the clinical routine. Primary amelanotic melanomas are even rarer. In our literature review, we found only six case reports of primary amelanotic CNS melanomas. Our case report describes the course of a 71-year-old man with a primary amelanotic CNS melanoma with secondary spread to the spine.

Pneumonitis in cancer patients receiving anti-PD-1 and radiotherapies: Three case reports.

INTRODUCTION: In development of novel therapies for the treatment of patient with cancer, the use of radiotherapy (RT) can produce significant local control and, in recent studies, has also been shown to mediate anti-tumor responses at distant sites by triggering and enhancing the endogenous cellular immune responses. Although RT induces an abscopal effect in some patients due to enhanced immune response to the tumor, immune-escape mechanisms, including up-regulation of programmed death-ligand 1 (PD-L1) on tumor cells, limit this benefit in other patients. Hence, many studies have promoted the synergy of RT and anti-programmed cell death protein 1 (PD-1) treatment for antitumor immunity. However, outcome may be improved when more therapies are combined, but risk of side effects can be increased. CASE PRESENTATION: We herein present 3 advanced cancer patients with pulmonary metastasis and who received RT. Later, they underwent anti-PD-1 treatment and unfortunately suffered from anti-PD-1-related pneumonitis over the nonirradiated areas after 4 cycles of treatment. The upregulation of cellular PD-1 expression in these areas was considered and the immune overreaction by anti-PD-1 treatment may cause these severe pulmonary adverse effects. CONCLUSION: Our review of 3 cases warrants careful workup to reduce the risk of side effects by combinative therapy with RT and anti-PD-1 treatment.

Scalp melanoma: Distinctive high risk clinical and histological features.

BACKGROUND/OBJECTIVES: Scalp melanoma has a worse prognosis than melanoma elsewhere, though the reasons for this are poorly understood. Current literature describing the clinicopathological associations of scalp melanoma is sparse. This study aims to compare clinical and histological features of scalp melanoma with other cutaneous head and neck melanomas (CHNM). METHODS: A cross-sectional study was performed of all primary CHNM cases seen by the Victorian Melanoma Service between 1994 and 2014, using prospectively recorded clinical data. Invasive and in situ melanomas were compared separately. RESULTS: Invasive scalp melanoma was associated with male sex (OR, 2.7; 95% CI, 1.9-3.9), increasing age (OR, 1.02 per year increase in age; 95% CI, 1.01-1.03), being first noticed by a person other than self, spouse/relative or doctor (OR, 2.9; 95% CI, 1.5-5.7), amelanosis (OR, 1.6; 95% CI, 1.1-2.3), and increased growth rate (OR, 1.14 per 1 mm/month growth rate increase; 95% CI, 1.04-1.26). Compared with other CHNM, scalp melanoma had greater median Breslow thickness (2.8  vs 1.2 mm) and was independently associated with satellite metastases (OR, 4.7; 95% CI, 1.9-11.5) and nodular subtype (OR, 1.8; 95% CI, 1.1-3.1). In situ scalp melanoma was associated with male sex, increasing age and solar keratoses. CONCLUSION: Scalp melanoma tends to occur in older men, is often rapidly growing and amelanotic, and is associated with high risk histological features. As it is likely to be overlooked, increased recognition of the atypical presentations of scalp melanoma is required.

Parotid Cystic Lesion in Amelanotic Malignant Melanoma.

A 60-year Brazilian woman, presented with an enlarged lymph node in the neck for one year, and a superficial nonulcerated lesion was observed in the scalp. Fine needle aspiration and biopsy of the lymph node revealed amelanocytic metastasis, and immunohistochemistry study showed Melan-A/ Mart-1 antigen (clone A103 and S-100 protein). The entire suspected area of the scalp was further resected and an amelanotic melanoma without angiolymphatic invasion was diagnosed. Ultrasonography and PET-computed tomography showed hypermetabolic cystic area in the right parotid. Furthermore, aspiration biopsy and surgical samples from parotid cyst confirmed the malignant amelanotic melanoma. Cystic metastases are scarcely reported in parotid gland, and can pose diagnostic challenges.

Parotid metastasis of an amelanotic melanoma of the scalp: The great masquerader.

BACKGROUND: Cutaneous melanoma is often characterized by its pigmented appearance; however, up to 8.1% of such lesions contain little or no pigmentation. Amelanotic melanomas, lesions devoid of visible pigment, present a diagnostic quandary because they can masquerade as many other skin pathologies. Recognizing amelanotic melanoma is even more clinically challenging when it is first detected as a metastasis to the secondary tissue. METHODS: We report a rare case of metastasis of an amelanotic melanoma to the parotid gland. RESULTS: A 75-year-old man presented with an 8-month history of a painless, mobile, hardened mass in the right parotid region. Histopathological analysis of a fine-needle aspiration biopsy of the parotid mass indicated that the mass was melanoma. Careful clinical and radiological examination revealed an 8 mm erythematous papule in the right temporal scalp, initially diagnosed by visual examination as basal cell carcinoma. After right superficial parotidectomy, neck dissection, and excision of the temporal scalp lesion, histological examination revealed the scalp lesion to be amelanotic melanoma. CONCLUSION: Although metastatic amelanotic melanoma to the parotid gland is a rare diagnosis, the clinician should be familiar with this presentation to increase the likelihood of making the correct diagnosis and delivering prompt treatment.

Amelanotic malignant melanoma of unknown primary origin metastasizing to the bone marrow: a case report and review of the literature.

We herein describe the case of a 77-year-old Japanese man who presented with progressive thrombocytopenia. No lymphadenopathies, bone lesions, hepatosplenomegaly or masses within any internal organs were detectable. Bone marrow smears revealed diffuse infiltration of large atypical cells morphologically resembling mature lymphoid neoplasms. A flow cytometric analysis showed that the tumor cells strongly expressed CD56 without myeloid or lymphoid antigens, suggesting that they were non-hematologic in origin. Ultimately, amelanotic malignant melanoma of unknown primary origin was diagnosed based on positive immunostaining for S100 proteins, HMB-45 and Melan-A. This case illustrates the usefulness of flow cytometric analyses for making such diagnoses. We also review the available literature on similar cases.

Highly pigmented Tg(Grm1) mouse melanoma develops non-pigmented melanoma cells in distant metastases.

Murine model systems are critically required tools for the investigation of unknown mechanisms of melanoma development and metastasis and for developing more efficient therapies. The Tg(Grm1)EPv melanoma mouse model is characterized by spontaneous development of pigmented cutaneous melanomas at hairless skin regions, with a short latency and 100% penetrance. Local metastasis was described in initial analyses; however, melanoma cells were not observed in distant organs. Here, we demonstrate that the established Tg(Grm1)EPv melanoma mouse model exhibits more extensive metastasis into distant organs than previously described. Disseminated cells undergo phenotypic changes, as we observed high numbers of non-pigmented Grm1-expressing melanoma cells within distant organs. As such changes during metastasis are common in human melanoma, our findings demonstrate that this mouse model represents an even more useful tool to study unknown mechanisms of metastasis in human melanoma than previously assumed.

[Space-occupying lesion of the ribs]. / Raumforderung in der Rippe.

An osteolytic tumor of the 7(th) rib was surgically removed from a 40-year-old patient. Immunohistochemical investigations showed that neither epithelial markers nor B and T cell markers were expressed in the tumor tissue; however, there was strong expression of VS38 and vimentin. These results were compatible with a solitary plasmocytoma of the bone. Further immunohistochemical investigations detected an expression of the melanoma markers S-100 and melan-A. The diagnosis of a metastasis of an amelanotic malignant melanoma could therefore be verified.

Dermoscopy: an aid to the detection of amelanotic cutaneous melanoma metastases.

BACKGROUND: The recognition of amelanotic cutaneous melanoma metastases (ACMM) remains a diagnostic challenge. OBJECTIVES: To describe and analyze the clinical and dermoscopic characteristics of ACMM. PATIENTS AND METHODS: Cases of ACMM were retrospectively selected from the image databases of three dermatology centers. The clinical and dermoscopic images were combined into one database for analysis. RESULTS: Forty-seven ACMM were observed in 18 patients. All lesions were erythematous, symmetric, dome-shaped papules or nodules appearing an average of 17 months after the diagnosis of the primary melanoma. ACMM presented as clinical outliers or as nonspecific papules found by palpation of the skin. The predominant dermoscopic feature was the presence of vascular structures, including serpentine (45%), glomerular (30%), irregular hairpin (23%) and corkscres-like vessels (19%). A few lesions also revealed crystalline (or shiny white lines) when viewed using polarized dermoscopy. CONCLUSION: ACMM should be considered in the differential diagnosis of new or persistent skin-colored or pink papules in patients with a previous history of invasive melanoma, especially if the lesions reveal atypical vessels under dermoscopy. The presence of crystalline structures may be another clue for the detection of some ACMM.

Whole-body 18F FDG positron emission tomography/computed tomography evaluation of patients with uveal metastasis.

PURPOSE: To investigate the value of whole-body positron emission tomography/computed tomography (PET/CT) as a screening tool for patients with uveal metastasis. DESIGN: Retrospective observational case series. METHODS: setting: Clinical practice. study population: Eighteen patients with uveal metastatic tumors were evaluated. Patients had no history of malignancy or a past medical history of malignancy without known active metastasis or known systemic cancer. intervention: Whole-body PET/CT was used as a screening tool to evaluate the intraocular tumor, to evaluate for multi-organ metastatic disease, and for cancer staging. main outcome measures: Detection and PET/CT uptake of primary tumors and metastatic disease. RESULTS: PET/CT imaging uncovered previously occult primary nonocular cancers (11/18, 61%), revealed progression of known primary systemic cancer (7/18, 39%), and confirmed multi-organ metastases in all cases (18/18, 100%). PET/CT findings were used to direct nonocular, confirmatory biopsy in 67% of cases (12/18). No uveal biopsies were required. PET/CT revealed lymph nodes and bone as the most common metastatic sites. The intraocular tumor was detectable in 28% of cases. Small, non-avid tumors and those within the hypermetabolic, PET-avid brain were falsely negative. CONCLUSION: This study suggests that whole-body PET/CT can be useful for clinical evaluation of patients with uveal metastases. It allowed for screening of the entire body and directed extraocular biopsy. Commonly used for tumor staging, PET/CT aided in the detection of the primary cancer in patients with metastatic uveal tumors.

[A case of rapidly progressive metastatic pulmonary amelanotic malignant melanoma 16 years after resection of melanoma].

An 80-year-old Japanese male was admitted to our hospital because of bloody sputum. He had a history of malignant melanoma of the left fourth digit, which was surgically excised 16 years previously. On hospital admission, chest computed tomography revealed several nodules in the lower lobes. He underwent thoracoscopic lung biopsy and amelanotic malignant melanoma was histologically diagnosed by immunohistochemical staining. The staining pattern with several antibodies was similar to that of the melanoma excised 16 years previously. Therefore, we concluded that the nodules in the lung were metastases of the malignant melanoma of the digit. Despite treatment with interferon, the nodules progressed rapidly, and the patient died 4 months later. This case suggests that the risk of recurrence with rapidly progressive distant metastasis should be considered in patients with malignant melanoma, even after a long disease-free interval. In addition, this case suggests that immunohistochemical stains with several antibodies are useful in the diagnosis of malignant melanoma.

Large neglected ulcerated melanoma mimicking extramedullary plasmacytoma.

Amelanotic melanoma, a renowned impersonator, has taken on a new persona. A 63-year-old woman was seen in the emergency room with a chief complaint of back pain after a fall and was discovered to have a 15-cm fungating mottled gray mass independent of bone on the right elbow. Initial workup discovered lytic calvarial lesions, anemia (Hb 7; Hct 20%), and circulating plasma cells consistent with plasma cell myeloma. Biopsy of the elbow mass displayed sheets of plasmacytoid cells, some reactive for CD138. Flow cytometry revealed a substantial portion of the plasma cells in the tumor that were kappa restricted consistent with cutaneous plasmacytoma. The elbow mass was initially signed out as extramedullary involvement by her myeloma. Reevaluation of the mass after the patient experienced an explosive growth of multinodular jet black malignant melanoma on ipsilateral breast revealed MART-1 and S-100 reactivity of the majority of the cells. In retrospect, the elbow mass was a neglected primary amelanotic malignant melanoma with neoplastic plasma cells participating in its chronic inflammatory infiltrate.