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1.
Middle East Afr J Ophthalmol ; 27(2): 134-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874049

RESUMO

Nodular posterior scleritis represents a small percentage of all cases of posterior scleritis. Because of the scarcity of nodular posterior scleritis, it may be confused or even misdiagnosed as an intraocular tumor or posterior uveitis. Here, we are reporting a case of nodular posterior scleritis in a 25-year-old medically free male. Furthermore, we reviewed previously reported cases of nodular posterior scleritis. Our patient presented with a choroidal mass of about one disc diameter in size. In addition, the patient had exudative retinal detachment and chorioretinal folds. B scan ultrasonography showed subretinal fluid, macular nodular thickening and underlying echolucent area along with medium internal reflectivity on A scan. Fluorescein angiography revealed early pinpoint areas of hyperfluorescence and late pooling under the detached retina. Indocyanine green angiography demonstrated early diffuse hypofluorescence corresponding to the area of detachment and late multiple pinpoint spots of hyperfluorescence. After intravenous methylprednisolone 1 g for 3 days followed by a course of oral prednisolone along with mycophenolate mofetil, the patient experienced rapid recovery with improvement in vision and complete resolution of subretinal fluid. On further follow-up, the patient regained 20/20 vision. Nodular posterior scleritis is a rare unilateral disease with strong female predominance. Multimodal imaging should be employed to confirm the diagnosis. The disease must be diagnosed correctly to avoid any unnecessary diagnostic work-up and aggressive management. Most cases carry excellent prognosis with no recurrence.


Assuntos
Neoplasias da Coroide/diagnóstico , Melanoma Amelanótico/diagnóstico , Descolamento Retiniano/diagnóstico , Esclerite/diagnóstico , Administração Oral , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias da Coroide/tratamento farmacológico , Corantes/administração & dosagem , Quimioterapia Combinada , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Verde de Indocianina/administração & dosagem , Infusões Intravenosas , Masculino , Melanoma Amelanótico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Imagem Multimodal , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Esclerite/tratamento farmacológico , Tomografia de Coerência Óptica
2.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621707

RESUMO

Oculocutaneous albinism is a genetically heterogeneous, autosomal recessive group of disorders characterized by a generalized decreased or absence of melanin pigment in the eyes, hair, and skin. These patients have a greater sensitivity to UV radiation and a predisposition to skin tumors, mainly squamous cell carcinoma and basal cell carcinomas, and to a lesser extent malignant melanomas. Melanoma can be one of the most challenging cancers to diagnose in patients with albinism. We report an uncommon clinical presentation of melanoma, an amelanotic melanoma in the right supraciliar region in a patient with oculocutaneous albinism. The clinical presentation was an erythematous, scaly and ill-defined plaque. The skin biopsy revealed a lentigo maligna melanoma. Amelanotic melanomas are one of the two most difficult to diagnose subtypes of melanoma, together with the nevoid type. Melanoma in oculocutaneous albinism patients are often amelanotic, which makes their clinical diagnosis very difficult. These patients should be examined in the dermatology department at least once a year and it is recommended to have a high index of suspicion.


Assuntos
Albinismo Oculocutâneo/complicações , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dermoscopia , Feminino , Humanos , Lactente , Masculino , Melanoma Amelanótico/complicações , Melanoma Amelanótico/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico
5.
BMJ Case Rep ; 12(10)2019 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-31611224

RESUMO

We report a case of a man aged 35 years who presented with the chief complaint of painless diminution of vision in the right eye for 4 months. Examination revealed a large inferior retinochoroidal mass along with retinal detachment. An anterior choroidal mass with moderate internal reflectivity was seen on B-scan ocular ultrasonography and MRI and CT scan were indicative of a mitotic aetiology. Fluorodeoxyglucose-positron emission tomography scan ruled out any other systemic foci of involvement. Based on the above findings, a provisional diagnosis of amelanotic choroidal melanoma was made and he was taken up for choroidal aspiration biopsy, wherein the cytopathology report revealed hypercellularity with no identifiable pigments. In view of the above, a diagnosticandtherapeutic enucleation was performed; however, the histopathology report of the enucleated specimen revealed poorly differentiated retinoblastoma. This case highlights that the diagnosis of retinoblastoma should be kept in mind even in adult patients.


Assuntos
Neoplasias da Coroide/diagnóstico , Melanoma Amelanótico/diagnóstico , Neoplasias da Retina/diagnóstico , Retinoblastoma/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino
8.
An Bras Dermatol ; 94(1): 86-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726470

RESUMO

We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Dermatoses do Pé/patologia , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Verrugas/patologia , Adulto , Biópsia , Diagnóstico Tardio , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Metástase Linfática , Melanoma Amelanótico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Verrugas/diagnóstico
9.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710904

RESUMO

Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.


Assuntos
Doenças do Pé/patologia , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Antineoplásicos Imunológicos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos , Doenças do Pé/diagnóstico , Doenças do Pé/terapia , Humanos , Fatores Imunológicos/uso terapêutico , Interferon-alfa/uso terapêutico , Masculino , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Nivolumabe/uso terapêutico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia
10.
An. bras. dermatol ; 94(1): 86-88, Jan.-Feb. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-983745

RESUMO

Abstract: We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Humanos , Feminino , Adulto , Neoplasias Cutâneas/patologia , Verrugas/patologia , Melanoma Amelanótico/patologia , Dermatoses do Pé/patologia , Neoplasias Cutâneas/diagnóstico , Biópsia , Verrugas/diagnóstico , Melanoma Amelanótico/diagnóstico , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Diagnóstico Tardio , Dermatoses do Pé/diagnóstico , Metástase Linfática
11.
J Am Acad Dermatol ; 80(5): 1292-1298, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30654075

RESUMO

BACKGROUND: Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. OBJECTIVE: To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). METHODS: A cross-sectional retrospective medical record review at a tertiary academic medical center. RESULTS: A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). LIMITATIONS: Retrospective study design, single-institutional study. CONCLUSION: Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Melanoma Amelanótico/patologia , Segunda Neoplasia Primária/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Erros de Diagnóstico , Feminino , Cor de Cabelo , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Melanoma Amelanótico/diagnóstico , Pessoa de Meia-Idade , Índice Mitótico , Segunda Neoplasia Primária/diagnóstico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Úlcera Cutânea/etiologia , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
13.
Arch Soc Esp Oftalmol ; 94(2): 81-84, 2019 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30342820

RESUMO

We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.


Assuntos
Perfuração da Córnea/etiologia , Neoplasias da Íris/complicações , Melanoma Amelanótico/complicações , Criança , Diagnóstico Diferencial , Enucleação Ocular , Hemorragia Ocular/etiologia , Humanos , Neoplasias da Íris/diagnóstico , Neoplasias da Íris/patologia , Neoplasias da Íris/cirurgia , Masculino , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgia
15.
World Neurosurg ; 122: 229-239, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30404049

RESUMO

BACKGROUND: Meningeal melanoma is a rare tumor of the central nervous system, whose amelanotic variant is called "amelanotic meningeal melanoma" (AMM). AMM does not produce melanin and therefore does not exhibit typical short T1 and short T2 signal on magnetic resonance imaging and thus can be easily misdiagnosed and be inappropriately managed. To date, only 4 AMM cases have been reported in the English literature. Here, we report the fifth case. CASE DESCRIPTION: A 26-year-old female patient presented with a 4-month history of progressive headache and nausea, the conventional magnetic resonance imaging demonstrated a posterior fossa mass accompanied by diffuse leptomeningeal dissemination. Repeated cerebrospinal fluid cytology screening showed negative results. The functional magnetic resonance examinations, including diffusion-weighted imaging, proton magnetic resonance spectroscopy, and dynamic susceptibility contrast perfusion-weighted imaging, provided complementary information. The final diagnosis of AMM was made by immunohistochemistry. Despite gross total excision of the tumor, the disease progressed, and the patient died 10 months after diagnosis. CONCLUSIONS: Our experience with this case demonstrated that meningeal melanoma should be included in the differential diagnosis when an intracranial mass is accompanied by leptomeningeal dissemination, and especially when proton magnetic resonance spectroscopy and dynamic susceptibility contrast perfusion-weighted imaging indicate a malignant tumor whereas diffusion-weighted imaging does not. And the loss of a typical melanin signal should not server as an excluding criterion for meningeal melanoma.


Assuntos
Melanoma Amelanótico/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meninges/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meninges/patologia , Meninges/cirurgia , Metástase Neoplásica/diagnóstico por imagem
16.
Intern Med ; 58(7): 969-972, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30449771

RESUMO

A 51-year-old man was diagnosed with stage IIC nodular malignant melanoma (T4bN0M0) of the right upper arm. The tumor was treatment-refractory, and left-sided pleural effusion emerged 1.5 years later. Aspiration of pleural fluid revealed abundant amelanotic, atypical cells that resembled epithelial malignant mesothelioma or lung adenocarcinoma cells; these cells were positive for melanoma-associated antigen recognized by T cells (MART-1)/Melan-A, HMB-45, and S-100 on immunocytochemistry. Thoracic computed tomography (CT) revealed marked diffuse pleural thickening in the left hemithorax that mimicked malignant mesothelioma; thus, the present report describes the unique cytological and radiological findings of this case.


Assuntos
Neoplasias Pulmonares/diagnóstico , Melanoma Amelanótico/diagnóstico , Mesotelioma/diagnóstico , Pleura/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Melanoma Amelanótico/cirurgia , Pessoa de Meia-Idade , Neoplasias Pleurais/cirurgia , Tomografia Computadorizada por Raios X
17.
BMJ Case Rep ; 20182018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30131413

RESUMO

Amelanotic melanoma of cervix is a rare and aggressive neoplasm and only few cases have been reported in the literature. We report a rare case of an amelanotic melanoma of the uterine cervix with extensive metastases and multiple subcutaneous nodules. Due to the unusual site and amelanotic nature of the lesion, chances of misdiagnosis are high and immunohistochemical markers for melanoma help establish the diagnosis. The possibility of metastasis from a primary malignant melanoma of the skin needs to be ruled out. The present case was initially misdiagnosed and treated on the regimen for squamous cell carcinoma, but progressed despite chemotherapy. After a thorough re-evaluation and applying extensive panel of immunohistochemistry, the diagnosis of an amelanotic malignant melanoma of uterine cervix was established.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Melanoma Amelanótico/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Colo do Útero/patologia , Diagnóstico Diferencial , Feminino , Humanos , Melanoma Amelanótico/patologia , Metástase Neoplásica , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias do Colo do Útero/patologia
19.
BMJ Case Rep ; 20182018 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-29602781

RESUMO

Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.


Assuntos
Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Biópsia , Diagnóstico Diferencial , Sobrancelhas , Pálpebras/cirurgia , Feminino , Humanos , Melanoma Amelanótico/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas/diagnóstico
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