Skin metastases of malignant melanoma clinically simulating folliculitis

Cutaneous metastases of malignant melanoma were seen as small red papules with central hair resembling the typical clinical picture of folliculitis. This type of cutaneous metastasis was observed in a 51-year-old woman 12 months and in a 42-year-old man 30 months after wide excision of cutaneous malignant melanoma, in both cases located on the lower extremity. The first case presented a reflux metastasis, the second case a hematogenous metastasis on the contralateral thigh. Histological findings concurrently revealed metastases of malignant melanoma located at the cutaneous-subcutaneous interface beneath the hair follicle. This type of cutaneous metastasis could be easily excised in toto by means of a 6 mm diameter punch biopsy.     

Melanomatous meningitis. Apropos of 3 cases

The meninges are frequently involved during the dissemination of malignant melanoma. This "meningeal melanoma" ranks fairly high on the list of metastatic meningites, side by side with meningeal carcinomatosis proper (i.e. related to a malignant epithelial tumour). Meningeal melanoma may be associated with a cerebral metastasis or isolated, as in the three cases reported here. Although its prognosis is sombre, its diagnosis is important since the possibilities of treatment are limited but exist. CASE-REPORTS: Case 1. This was a 68-year old woman who had initially presented with malignant melanoma in the maxillary region (SSM level IV, thickness 2.9 mm). Two years after the primary tumor was excised, secondary lesions developed in the lymph nodes and bones. A few weeks later, the patient fell into mental confusion progressing towards delusion of persecution. Neurological examination and CT scans were normal, but numerous melanoma cells were found in the CSF. This woman died one month after the first neurological signs had appeared. Case 2. This 63-year old man presented with bilateral axillary adenopathy and inflammatory thoracic plaques which at histology had proved to be metastases from a malignant melanoma of the shoulder surgically treated 10 years previously. After 14 months of almost complete remission under multiple chemotherapy (CPDD, ACTD, VDS), headaches and lumbosacral pain developed. Standard radiography and CT of the spine gave normal results, and it was only at the third lumbar puncture that the CSF was found to contain malignant cells. The patient died 2 months after the first neurological manifestations. Case 3. A 42-year old woman developed headaches and dysesthaesia in the arms and head. This was followed by oppositional semi-mutism. All exploratory examinations were normal, except for that of the CSF which showed 18 cells/mm3, 50 p. 100 of which were melanoma cells. The patient was transferred to the Dermatology department where he underwent excision of a left scapular melanoma difficult to classify (malignant blue naevus?). Combined treatment with Fotemustine* and DTIC produced an incomplete but relatively prolonged response. Death occurred after 8 months. DISCUSSION: A. Meningeal melanoma accounts for about 10 p. 100 of all metastatic meningites. The most frequent primary tumours in meningeal carcinomas are breast cancer and lung cancer. Malignant melanoma ranks third or fourth, but when the relative frequency of each of these three malignant diseases is taken into account, it appears that the risk of malignant melanoma is higher than that of any other solid tumour. B. In 410 cases extracted from the literature, the meninges were involved in 30 p. 100 of malignant metastatic melanomas found at autopsy. There is no publication that makes it possible to evaluate the relative frequency of melanomas affecting only the meninges or coexisting with cerebral metastases. This also applies to meningeal melanoma associated with non-neuro     

Interdigital amelanotic spindle-cell melanoma mimicking an inflammatory process due to dermatophytosis

Herein, we report a rare case of amelanotic spindle-cell melanoma on the interdigit of the left fifth toe of an 83-year-old woman. She also had tinea pedis on the same part for more than 2 years, and the part in which the tumor developed had been macerated and colonized with both Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Histopathologically, the biopsy specimen was indistinguishable from that of nonspecific inflammatory granulation. Two biopsies could not lead us to the correct diagnosis until the totally excised specimen was evaluated with immunohistochemical analysis including S-100 and other melanocyte markers. The patient died with multiple metastases of the tumor 18 months after her first visit. This case suggests that refractory interdigital dermatophytoses should be treated by considering the possibility of concomitant malignant neoplasms, and immunohistochemical analysis is indispensable for differential diagnosis of malignant neoplasms suggesting nonspecific granulation.     

Early detection of lymph node metastases by 7.5 MHz-ultrasound examination in a patient with primary malignant melanoma of the lung

Primary malignant melanoma of the lung (PMML) is a rare neoplasm that may be misdiagnosed as one of the more common types of lung cancer. Most cases are characterized by a very poor prognosis, ultimately leading to the patient's death. Since an optimal systemic treatment schedule is not established so far, early detection of lymph node metastases may be important for surgical interventions. We report on a 55-year-old male patient with a primary bronchial malignant melanoma of his left lower lobe that was treated by pneumonectomy. 11 and 17 months after removal of the PMML, suspicious lymph nodes in the patient's left axilla were identified by 7.5 MHz-ultrasound examinations. Again surgical treatment was performed and histopathology showed lymph node metastases of malignant melanoma. During adjuvant therapy with interferon alpha (3 x 6 Mio IE per week) no further relapse has been observed with a follow-up of 8 months after the last operation. An overview of primary melanoma of the lung is given and diagnostic options are discussed. The 7.5 MHz-ultrasound examination appears to be especially helpful in the early detection of lymph node metastases leading to early initiation of surgical treatment possibly associated with a prolonged survival in our patient.     

Peutz-Jeghers syndrome associated with primary malignant melanoma of the rectum

An 85-year-old Chinese woman was found to have mucocutaneous pigmentation involving the lips, buccal mucosa, hard palate and the buttocks when she presented with primary malignant melanoma of the rectum. Multiple brown-black pigmentation was also noted in the anal canal and the adjacent mucosa surrounding the tumour. This is the first report of Peutz-Jeghers syndrome associated with malignant melanoma of the rectum.     

Diffuse Braunf?rbung von Haut, Schleimhaut und Urin

A 45-year-old woman presented with diffuse melanosis, icteric sclera and melanuria. Physical examination revealed a massive nodular melanoma with ulceration and satellite metastases on the back. Further investigation showed distant cutaneous and visceral metastasis. After palliative debulking along with postoperative multidrug chemotherapy, the patient has shown objective disease regression for more than 11 months. However, it remains to be seen if disease regression will translate into increased survival.     

Diffuse brown discoloration of skin, mucosa and urine

A 45-year-old woman presented with diffuse melanosis, icteric sclera and melanuria. Physical examination revealed a massive nodular melanoma with ulceration and satellite metastases on the back. Further investigation showed distant cutaneous and visceral metastasis. After palliative debulking along with postoperative multidrug chemotherapy, the patient has shown objective disease regression for more than 11 months. However, it remains to be seen if disease regression will translate into increased survival.     

Intravascular metastatic melanoma of the vena saphena magna

BACKGROUND: Melanoma blood vessel metastases are very uncommon. We report the first recorded case of intravascular metastatic melanoma of the vena saphena magna. CASE REPORT: A 74-year-old woman presented with a swelling of the upper third of her left thigh and was suspected of superficial thrombophlebitis. Two intravascular black masses were excised in the vena saphena magna. Histopathologic examination showed an endovascular metastatic melanoma positively staining for HMB45 and S-100 proteins. Acral-lentiginous melanoma of her big toe was then found. Subcutaneous lymph node and chest metastases were discovered and treatment with dacarbazine was initiated, followed by treatment with fotemustine. The patient died 21 months after the diagnosis was made. CONCLUSIONS: Only a few cases of blood vessel metastatic melanoma have been reported. We here report the first recorded case, to our knowledge, of intravascular metastatic melanoma of the vena saphena magna. Surgical exploration allowed rapid diagnosis, and histological examination confirmed the intravascular nature of a hematogenous melanoma metastasis. This case clearly illustrates the need for histologic examination of any thrombotic material.     

Placental metastasis of maternal melanoma

Metastasis of maternal malignant tumor to the products of conception is a rare event. Melanoma is the most common maternal malignant tumor to metastasize to the placenta and the fetus. We report the case of a 28-year-old woman with melanoma during pregnancy. At parturition, histologic evaluation of the placenta revealed metastatic melanoma, and multiple organ metastasis developed. The infant was free of disease. Metastasis to products of conception portends a poor prognosis for the mother. To our knowledge, this report is the first of a patient with melanoma metastasis to the placenta to survive more than 7 months after parturition. As caretakers of patients with melanoma, dermatologists are in a position to coordinate and direct the care and follow-up treatment of affected patients.     

Intratracheal metastasis from malignant melanoma.

Malignant melanoma is increasing in incidence in most countries. Distant metastases are common but intratracheal metastasis is extremely rare. We report a 54-year-old man who presented with increasing dyspnoea. Symptomatic treatment for asthma had been of no effect. Bronchoscopy showed that trachea was nearly occluded by a tumoral mass, and biopsy proved this to be a metastasis of malignant melanoma. The man's breathing difficulties disappeared after local laser therapy, but 2 months later he presented with symptoms of multiple brain metastases.     

Congenital malignant melanoma

A case is reported of congenital malignant melanoma that occurred in the absence of maternal melanoma or a congenital giant naevus. The patient had the melanoma on the left thigh excised 54 days after birth, but later died at the age of 18 months with multiple metastases.     

Melanophagic dermatitis and panniculitis. A condition revealing an occult metastatic malignant melanoma

A 32-year-old woman had a dozen slate-blue cutaneous macules of recent onset. Histologic examination of multiple skin biopsies revealed melanophagic dermatitis and panniculitis accompanying a few occult metastases of malignant melanoma. The primary site of the neoplasm remained undiscovered. The pathogenesis of melanophagic dermatitis and panniculitis is presumably related to the spontaneous regression of metastases.     

Dural Melanoma Associated with Ocular Melanosis and Multiple Blue Nevi

BACKGROUND: Primary meningeal melanomas of the central nervous system (CNS) are a rare malignant process with the majority originating from the leptomeninges. Primary dural melanomas have been reported to occur in isolation or in conjunction with Nevus of Ota. The association of primary dural melanoma with multiple cutaneous blue nevi has not been reported previously. OBJECTIVE: To describe a case of a 41-year-old Asian woman patient with a primary dural melanoma that arose in association with ocular melanosis and multiple cutaneous blue nevi. The patient is alive almost more than 8 years after subtotal and subsequent total resection of her primary tumor. Primary dural melanomas, Nevus of Ota, and blue nevi are discussed in relation to their coexistence and potential for intracranial melanoma. CONCLUSION: CNS melanoma is regarded as an extremely aggressive disease with poor prognosis. This case and previous reports of dural melanomas occurring in isolation or with Nevus of Ota have demonstrated relatively prolonged survival after surgical intervention. We conclude that dural melanomas are less aggressive tumors requiring surgical extirpation only.     

Neurokutane Melanose und malignes Melanom

A 36-year-old man presented with a giant congenital melanocytic nevus and multiple disseminated melanocytic nevi. After he had developed neurological symptoms (grand mal seizures), a cerebral metastasis of a malignant melanoma without a primary melanoma was found. The patient was diagnosed as having a neurocutaneous melanosis with a cerebral metastasis. In spite of a variety of therapeutic attempts (surgery, radiation therapy and chemotherapy) he followed a rapidly progressive, lethal course with increased intracranial pressure, hydrocephalus and spinal metastases.     

Metastasis of a malignant melanoma 2 years after carbon dioxide laser treatment of a pigmented lesion: case report and review of the literature

A 64-year-old woman with a clinically diagnosed 'lentigo simplex' on her right cheek was dermatologically treated several times with a CO2 laser. Three years later she showed a metastasis of a malignant melanoma in her right parotid gland. Considering this case, as well as other published cases reporting malignant melanomas occurring after laser treatment, we again underscore that naevomelanocytic lesions are not a routine indication for laser treatment.     

颅内转移性黑素瘤5例临床分析

目的：讨论颅内转移性黑素瘤的临床表现、影像学特征及治疗方法。方法：对本科近17年来治疗的5例颅内转移性黑素瘤，进行回顾性分析。结果：颅内转移性黑素瘤的临床表现不具有特征性。影像学上CT表现为高密度或混杂密度，增强扫描呈不同程度强化。核磁共振检查(MRI)表现为短T1短T2信号，也可以因顺磁性黑素含量不同和瘤内有无出血表现为高、低或混杂信号，注射二乙胺五乙酸钆(GD—DTPA)后出现不同程度的强化。5例患者中，3例手术全切，1例大部分切除，1例未手术。结论：颅内转移性黑素瘤的预后差，应在手术基础上进行包括放疗及化疗的综合治疗。     

Epidermotropism in Melanoma

Multiple malignant melanocytic lesions developed in a 54-year-old man 4 years after a primary malignant melanoma (Clark level IV) had been excised and 2 months after taking L-Dopa for Parkinsonism. Several of the recurrent lesions that showed junctional melanocytic components were considered primary melanomas and it was suggested that L-Dopa was responsible for malignant transformation of nevi and for rapid progression of the disease. The case was re-examined and on recent evidence it is likely that these lesions were epidermotropic metastases and that L-Dopa played no part in the progress of this unusual tumor.     

Glomangiosarcoma of the hip: report of a highly aggressive tumour with widespread distant metastases

Malignant glomus tumour is an extremely rare neoplasm, and only a few cases with local invasive or aggressive features have been described to date. We present a distinctive case of a malignant glomus tumour arising on the skin of the left hip of a 47-year-old woman. The primary tumour was small, with a maximum diameter of 1 cm, but 2 years after the tumour was excised, multiple lung and skin metastases appeared. Post-mortem examination also revealed widespread metastases in almost all of the visceral organs. Histological examination showed that the primary tumour was composed of a sheet-like proliferation of epithelioid round or short spindle cells surrounding small venules. In addition, there was a proliferation of long spindle cells with eosinophilic fibrillary cytoplasm, which mimicked a leiomyosarcoma. The tumour cells were intensely immunopositive for actin and vimentin but were negative for desmin. This is an exceptional case of malignant glomangiomyoma with widespread metastases, which represents a distinct variant of de novo glomangiosarcoma.     

A case of Werner syndrome with three primary lesions of malignant melanoma

Three primary lesions of malignant melanoma developed in a 44-year-old Japanese woman with Werner syndrome. One lesion was on the right large pudental lip and the others in distinct locations on her left sole. After the wide local excision of these tumors, the wound of the large pudental lip was sutured, and the defects on the sole were covered with skin grafts. After one course of chemotherapy consisting of dacarbazine, nimustine, vincristine sulfate and local injection of Interferon beta were performed, severe myelosupression occurred and continued for two months. Defective production of WRN protein was confirmed by Western blotting, although the three representative mutations in Japanese patients, mutations 1, 4 and 6, which include over 90% of the Japanese patients, were not detected. We also reviewed 26 cases of malignant melanoma associated with Werner syndrome (WS), including ours.     

Cutaneous malignant melanomas occurring under cyclosporin A therapy: a report of two cases

Two patients are reported with cutaneous malignant melanoma who had been on treatment with cyclosporin A. The first case was a 44-year-old man with systemic sclerosis and the second a 52-year-old woman who had a renal transplant. In both cases cyclosporin A was administered with a low dose of prednisone.