Tattoo pigment in sentinel lymph nodes: a mimicker of metastatic malignant melanoma

Tattoo pigment in the sentinel lymph nodes of melanoma patients represents a clinical challenge. If a tattoo is present in the area of the primary melanoma, the draining lymph nodes are likely to contain tattoo pigment, as well as being the site for metastatic deposits of melanoma. We describe a case report involving an elderly Caucasian male diagnosed with a Clark level-4 nodular malignant melanoma, wherein intraoperatively we encounter a darkly pigmented lymph node highly suspicious for metastatic disease. The patient had a tattoo in the vicinity of the malignant melanoma The specimen is sent for histological examination and is found to contain pigmented macrophages, but metastatic malignant melanoma is not identified. Histological confirmation of an enlarged pigmented node is essential before radical surgery is performed.     

Tumoral melanosis involving the sentinel lymph nodes: a case report

Tumoral or nodular melanosis is characterized by a clinical lesion suspicious for malignant melanoma, the histopathological correlate is a nodular accumulation of melanophages in the dermis. We present a patient with nodular melanosis involving also the sentinel lymph nodes and discuss possible differential diagnoses as well as prognostic and therapeutic implications.     

A case report of disappearing pigmented skin lesions associated with pembrolizumab treatment for metastatic melanoma

Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death (PD)‐1 receptor. Common cutaneous adverse side‐effects of PD‐1 inhibitors include maculopapular rash, pruritus, vitiligo and lichenoid skin and mucosal reactions. Here we describe a man in his sixties with metastatic melanoma treated with pembrolizumab who subsequently developed fading or disappearance of pigmented skin lesions, lightening of the skin, and poliosis of the eyebrows, eyelashes and scalp and body hair. Compared with baseline high‐resolution three‐dimensional total‐body photography, we observed fading or disappearance of solar lentigines, seborrhoeic keratoses and melanocytic naevi, suggesting that PD‐1 inhibitors may affect the evolution of these benign skin lesions. With dermatoscopic follow‐up, altered lesions showed either blue‐grey peppering/granularity or fading in colour without other identifiable features. No halo lesions or lesions with surrounding inflammation were identified. One changed pigmented lesion that showed blue‐grey peppering/granularity on dermoscopy was biopsied and interpreted as a macular seborrhoeic keratosis with melanophages. Further studies are required to elucidate the effects of PD‐1 inhibition on benign skin lesions.     

Incidental findings in negative sentinel lymph nodes of patients with malignant melanoma: report of three cases

We present three cases of benign SLN that were clinically suspicious for involvement by metastatic melanoma and where found to be involved with other diseases or deposits previously unknown.     

Treatment of extensive cutaneous metastatic melanoma with topical diphencyprone

Diphencyprone is a potent contact sensitizer sometimes used to treat alopecia areata and cutaneous warts. A patient with previous primary nodular melanoma on the scalp developed extensive, confluent cutaneous metastases near the primary site, unsuitable for treatment with surgery or radiotherapy. Topical treatment with diphencyprone as a single agent resulted in regression of all lesions, and the patient remains well 18 months later. Topical immunotherapy with diphencyprone was an inexpensive and well-tolerated treatment for extensive cutaneous melanoma metastases in our patient unsuitable for other therapies.     

Melanoma erysipeloides: inflammatory metastatic melanoma of the skin

We report a case of diffuse infiltration of the skin of the chest wall with metastatic melanoma. This developed as a direct extension from right axillary lymph nodes. Histology and immunohistochemistry showed invasion of dermal lymphatics with melanoma cells.     

转移性恶性黑素瘤一例

患者女,62岁,因右腹股沟包块4个月入院。患者于2018年1月2日因右足拇趾单侧疼痛流脓4个月,在江苏省苏北人民医院手足外科行右拇趾肉芽组织切除、嵌甲根治术,术后切口愈合良好……     

Dermatofibroma in a black tattoo: report of a case

Tattooing has been associated with a variety of complications including inflammatory and granulomatous reactions, transmission of infections, and neoplasms. We report a case of a 24-year-old male who presented with a 2-month history of an erythematous nodule involving a newly made tattoo on the right leg. An excisional biopsy was performed and the histopathological evaluation was consistent with dermatofibroma. Only three cases of dermatofibroma associated with tatooing were reported in litetature. We report an additional case and review the literature regarding cutaneous reactions to tattoos.     

Quantification of melanoma micrometastases in sentinel lymph nodes using real-time RT-PCR

Detection of micrometastases in the regional tumor-draining lymph nodes is critical for staging and prognosis in melanoma patients. We applied a quantitative multiple-marker RT-PCR assay to improve the detection of occult melanoma cells in the sentinel lymph node (SLN). From 139 patients with primary cutaneous melanoma who underwent sentinel lymphadenectomy, a total of 235 SLN were assessed for Melan-A and tyrosinase expression by real-time quantitative RT-PCR. Twenty-three patients (17%) were positive by histopathology and expressed messenger RNA of one or two markers. Of the patients with histopathologically negative SLN 39 (28%) were reclassified by positive RT-PCR. Patients were examined for tumor recurrences during a median follow-up period of 29 mo. Tumor recurrences were demonstrated in eight patients (35%) with histopathologically positive SLN, in four patients (10%) with submicroscopic tumor cells detected exclusively by real-time RT-PCR, and in none of the patients negative by both methods. The differences in recurrence rates were statistically significant (p=0.01). These data indicate that real-time quantitative RT-PCR for the detection of minimal residual melanoma in SLN improves the prediction of disease-free survival.     

A tattoo and localized lymphadenopathy: a case report.

We report the case of a left inguinal lymph node enlargement in a young man. A tattoo was present in close proximity to the lymph node and had preceded its enlargement by several years. The lymph node was removed surgically, and pathologic examination showed it to contain dark pigment material characteristic of a tattoo. The clinical significance of this finding is discussed, and the relationship of tattoo lymphadenopathy to inflammatory skin reactions and to dermatopathic lymphadenopathy is considered.     

转移性血管瘤样黑素瘤一例

恶性黑素瘤（MM）是黑素细胞起源的高度恶性肿瘤,具有侵袭性强、易发生早期转移及死亡率高等特点。血管瘤样黑素瘤（angiomatoid melanoma,AMM）是近期报道的一黑素瘤的组织学亚型,极为罕见,组织学上易误诊为血管性肿瘤。AMM的组织学改变可见于原发性黑素瘤,也可见于转移性黑素瘤。施启丰等［1］报道1例原发性AMM,现将我们诊治的1例转移性AMM报道如下……     

Animal type melanoma: a report of a case with balloon-cell change and sentinel lymph node metastasis

Animal type melanoma is a rare histopathologic variant of melanoma characterized by sheets and nodules of heavily pigmented epithelioid melanocytes that involve the entire thickness of the dermis. This human neoplasm mimics melanocytic neoplasms seen in gray horses and laboratory animals; thus, is termed animal type melanoma. It is quite rare and, with only a few reported cases, its biological behavior is not well understood. We report an example of animal type melanoma on the back of a 27-year-old man. The lesion showed areas of melanoma in situ, which ruled out the possibility of metastatic melanoma. Features of regression were also seen at dermo-epidermal junction and papillary dermis. In some areas, neoplastic melanocytes exhibited a balloon-cell appearance; in others the neoplasm was composed of sheets and fascicles of heavily pigmented epithelioid melanocytes that permeated the entire dermis and extended into the dermal-subcutaneous interface, mimicking a cellular blue nevus. Epithelioid melanocytes in deeper areas showed abundant, heavily pigmented cytoplasm and pleomorphic nuclei with prominent eosinophilic nucleoli and some mitotic figures. The neoplastic cells did not show evidence of maturation in deeper areas of the lesion. In some sections, a nodule of heavily pigmented epithelioid melanocytes was seen far from the main bulk of the lesion, at the dermal-subcutaneous interface, raising the possibility of a satellite lesion. A lymphoscintigraphy showed a sentinel lymph node in the right axilla and a subsequent axillary lymphadenectomy demonstrated that the architecture of the sentinel lymph node was effaced by metastatic melanoma. The patient received adjuvant chemotherapy with inteferon alfa-2b and four months after this treatment the patient is alive and well, without evidence of recurrences or additional metastases.     

Syphilitic juxta-articular nodes: case report.

Multiple juxta-articular nodes occurring in usual and unusual sites in a patient with late syphilis are described.     

甲下黑素瘤一例

患者，男，58岁。右足拇趾趾甲色黑7年余，病理确诊为甲下黑素瘤。经系统检查后未发现淋巴结转移，于肿瘤医院行远节拇趾截趾术，术后仍在随访中。