engleski

A case of ulcerated giant melanoma in a young adult

INTRODUCTION & OBJECTIVES: Melanoma is one of the most frequently occurring neoplasms worldwide, with up to 2.1% of the population being diagnosed at some point during their lifetime. Nodular melanomas are relatively common, but melanomas greater than 10 cm in size are rarely seen in practice. We present a clinically impressive and rarely encountered scenario of a rapidly progressing giant melanoma in a young adult. MATERIAL & METHODS: A single case report is presented. RESULTS: A 33-year old Caucasian male in good previous health presented with a 2-month history of a rapidly growing tumour on his left thigh. As reported by the patient, the tumour originated from a mole that was present since early childhood. He also complained of inexplicable weight loss, intermittent pain irradiating throughout his body, as well as recent onset of cough and a low-grade fever. On examination, a protruding fungoid mass measuring approximately 12x10x2 cm was evident on the upper portion of the patient’s left thigh. It was centrally necrotic and ulcerated, malodourous, with evidence of recent bleeding. The left inguinal region had multiple enlarged, firm and densely packed lymph nodes. In line with the patient’s history of a previous mole at the tumour site, malignant melanoma was initially suspected, however due to the impressive size, ulceration, rapid growth and lack of pigment traces, differential diagnosis included lymphoma and sarcoma. After wide surgical excision and ipsilateral lymph node dissection, histopathology confirmed a diagnosis of nodular melanoma with Breslow thickness of 20 mm, ulceration, 5 mitoses per square mm, lymphatic invasion, BRAF V600K mutation and multiple nodal macrometastases. Within 3 weeks of surgery, the patient developed right-sided muscle weakness and was diagnosed with multiple brain, liver and lung metastases. He was initially subjected to palliative radiotherapy of the central nervous system however a final management plan was not feasible because the patient deceased shortly thereafter. CONCLUSIONS: This case illustrates a rare presentation of nodular melanoma with an uncommonly large, fungating tumour and extremely rapid disease progression. Such thick melanomas are usually encountered in elderly patients due to fear of disease or self- negligence but our case highlights that we should consider giant melanoma in the differential diagnosis of large skin tumours even in young adults. Unfortunately, this specific group of patients has a significantly higher probability of developing early metastases and curative treatment is rarely possible. Therefore, to prevent such ominous prognosis, patient education and preventive skin examinations should be the mainstay of early recognition of melanoma.

giant melanoma; histopathology

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