epidermis. These features might be related to a block in the S phase of the cell cycle. On the other hand, the calprotectin immunolabelling throughout the epidermis appeared strikingly motheaten indicating severe vacuolar alterations. As seen in other disorders, the Mac 387-positive keratinocytes were either metabolically altered or engaged in a regenerative phase. The combination of these features was interpreted as a sublethal sign. The dermal dendrocyte alterations were reminiscent of the methotrexate-induced changes. 6 In some instances, CAR associated with anti-cancer treatment may be predictive for the drug efficacy. 7 Such a feature has not been evaluated so far for pemetrexed.

Sentinel lymph node biopsy is widely performed in cutaneous melanoma. Histologic confirmation of any enlarged, pigmented SLN is essential prior to radical surgery, especially when pigmented SLNs are found near a tattoo. Tattoo pigments may deposit in the regional lymph nodes and may clinically mimic metastatic disease. A history of tattooing should be considered in all melanoma patients eligible for SLNB. In a finding of darkly pigmented nodes during SLNB, radical lymphadenectomy should be withheld until immunohistologic confirmation of metastasis in the SLN is obtained.

Patients with MPM, especially men with skin phototype II, have a significantly increased incidence of developing SPC, particularly NMSC. Thus, careful monitoring is essential not only to detect recurrence of the original cancer or development of another primary melanoma, but also development of new malignancies of different types, particularly NMSC.

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