A Case of Malignant Melanoma Presenting as a Breast Mass

Kim, Tae Yun; Chae, Man Kyu; Kim, Hyung Hwan; Kim, Sung Yong; Baek, Moo Jun; Lee, Moon Soo; Kim, Chang Ho; Kim, Eui Han; Lee, Min Hyuk; Cho, Moo Sik; Song, Ok Pyung

doi:10.4048/jkbcs.2003.6.1.35

Cited by 5 publications

(6 citation statements)

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“…Approximately 5% of melanomas originate primarily from non-cutaneous sites. 12 There have been several reports of melanomas arising from the skin of the breast. 13 – 15 In retrospective studies, melanoma has been found to account for up to 38.5% of metastasis from solid neoplasms affecting the breast.…”

Section: Discussionmentioning

confidence: 99%

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Concurrent BRAF and PTEN mutations in melanoma of unknown origin presenting as a breast mass

Agosto‐Arroyo

Rosa

Chau

et al. 2017

SAGE Open Medical Case Reports

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Background:Metastases represent a small percentage of the malignancies affecting the breast, and only 5% of melanomas originate from non-cutaneous sites. Multiple genetic aberrations have been associated with the development of melanocytic lesions, including BRAF V600E mutation. Mutations in PTEN gene have also been related to the pathogenesis of multiple malignancies.Purpose/Method:This is the case of a 28-year-old female who presented with a tender, palpable mass in the upper outer quadrant of the right breast. Ultrasound showed a 1-cm solid mass, initially diagnosed as invasive ductal carcinoma on biopsy. During pre-operative workup, a second mass was identified and biopsied. Immunohistochemical stains performed on the second mass biopsy demonstrated that the neoplastic cells were positive for cytokeratin AE1/3, pan-melanoma, tyrosinase, and SOX-10 and negative for CK7, CAM5.2, and GATA-3. Subsequent workup showed widespread metastatic disease involving the liver, lungs, bones, and brain. The brain metastasis tested positive for BRAF p.V600E and PTEN p.R130Efs*4 mutations. Thorough skin and eye examination did not reveal a primary melanoma.Conclusion:Only few reports have been published of melanoma presenting as a breast mass. This is an interesting case due to the clinical presentation, diagnostic challenges, and genetic mutations profile.

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Section: Discussionmentioning

confidence: 99%

“… 19 Similar cases of melanoma affecting the breast without demonstrable cutaneous lesions or systemic metastasis have been described, predominantly in females aged 45–56 years old. 12 , 20 No molecular studies were performed on any of these previously described cases.…”

Section: Discussionmentioning

confidence: 99%

Concurrent BRAF and PTEN mutations in melanoma of unknown origin presenting as a breast mass

Agosto‐Arroyo

Rosa

Chau

et al. 2017

SAGE Open Medical Case Reports

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“…However, the distinction between a primary melanoma of the breast and a melanoma metastasis of the mammary parenchyma is done by the site and presentation of the mass, with a large papillary or polypoid lesion emerging from a unique pedicle in favour of the former (22) Moreover, a primary melanoma of the breast should present -at the microscopical evaluation -clustered melanocytes at the epithelial-stromal interface, juxtaposed to the tumoral lesion; this junctional component is considered by some study authors as the most compelling marker for primary melanomas arising in uncommon sites (23). Furthermore, on a histological note, minimal or absent epithelial hyperplasia, as well as no evidence of in-situ carcinoma, are described in the tissues adjacent to the metastatic melanoma (21).…”

Section: Primary Breast Melanoma Vs Melanomaderived Breast Metastasismentioning

confidence: 96%

“…From an imagistic point of view, the aspect of a metastatic mass is more frequently discrete, round and without spiculation, resembling certain primary mammary malignant lesions, such as papillary, medullary or mucinous carcinomas (21). However, the distinction between a primary melanoma of the breast and a melanoma metastasis of the mammary parenchyma is done by the site and presentation of the mass, with a large papillary or polypoid lesion emerging from a unique pedicle in favour of the former (22) Moreover, a primary melanoma of the breast should present -at the microscopical evaluation -clustered melanocytes at the epithelial-stromal interface, juxtaposed to the tumoral lesion; this junctional component is considered by some study authors as the most compelling marker for primary melanomas arising in uncommon sites (23).…”

Section: Primary Breast Melanoma Vs Melanomaderived Breast Metastasismentioning

confidence: 99%

Breast Metastasis of a Completely Regressed Cutaneous Melanoma – Case Report and Review of Literature

Boșoteanu

Aşchie

Tony

et al. 2021

ARS Medica Tomitana

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Spontaneous regression of cutaneous melanoma represents a more frequent circumstance in tumors with intense MelanA immunoprofile. Melanoma-derived breast metastases are uncommon and have been predominantly reported in premenopause, as an indicator for widespread disease. We report the case of a 60-year-old female patient, who presented to the surgical department after auto-palpation of a left mammary mass. Digital mammography indicated malignant characteristics, also objectified in the ipsilateral axillary lymph nodes. The microscopical examination and immunohistochemical profile revealed left nodal and upper-outer mammary quadrant metastases of a BRAF-positive achromic melanoma. The clinical and dermoscopic evaluation confirmed the complete regression of the malignant melanocytic lesion, localised at the level of the right inframammary fold. The upper-outer breast quadrant designates the main site of primary tumors (66%), as well as metastases of other malignancies (50%), due to its well-represented vascularisation and glandular tissue. Dermoscopic characteristics of regressed melanoma comprise scar-like depigmentation and polymorphous vessels (irregular linear and globular). The particularities of this case include the age > 40 years old, survival under therapy with Vemurafenib superior to that cited in the literature (24 months to this date), the involvement of the contralateral lymph nodes in relation to the skin lesion and the inverse diagnostic approach – from pathologist to dermatologist. Completely regressed achromic melanoma, identified through diagnostic techniques performed on clinically apparent loco-regional and distant metastases, represents a rare dermato-oncological entity, with controversial implications regarding the prognosis and survival, that requires future histopathological and dermoscopic homogenization.

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“…The existence of melanotic tumor cells surrounded by normal glandular tissue favors the metastatic origin of the lesion. 25 Nevertheless, fine needle cytology seems inadequate to confirm the diagnosis of either PMMB or metastatic melanoma as a result of the varying cellular morphology and the possible absence of pigmentation. The cytologic variants of metastatic lesions using FNA include spindle cells, epithelioid, pseudopapillary, pleomorphic, melanin-rich, and lymphoma-like variants.…”

Section: Differential Diagnosis Of Primary and Metastatic Melanomas Ofmentioning

confidence: 99%

Malignant melanoma of the breast: controversies in the diagnosis and therapeutic management of a rare nosologic entity

et al. 2020

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Melanoma of the breast is an infrequent entity, presenting as either primary or metastatic from extramammary solid neoplasms. Depending on the involvement of the skin, primary malignant melanoma of the breast (PMMB) can be classified as cutaneous or noncutaneous. Cutaneous PMMB accounts for <5% of all melanomas and only 0.5% of all breast cancers. Furthermore, despite the rarity of metastatic breast neoplasms, melanoma comprises a frequent source of metastases. Metastatic potential of melanoma is associated with poor prognosis, and the majority of patients present more than one metastatic foci at the time of diagnosis. Diagnostic approach for both primary and metastatic melanomas of the breast is substantiated by fine needle aspiration (FNA) cytology along with immunohistochemistry. Nevertheless, verification of a metastatic mammary melanoma requires the discovery of a primary lesion. The mainstay of treatment for primary tumors is surgery, with radical local excision and axillary lymph node dissection or, on occasion, axillary sentinel node resection, while for metastatic tumors it depends on the specificities of the melanoma. Adjuvant therapy is always implemented. The aim of this survey is to meticulously review the literature of primary and metastatic malignant melanomas of the breast and report epidemiologic and clinicopathologic data for this rare entity. Clinical features, histogenesis, morphological, and immunochemical findings are discussed, while the role of current diagnostic and therapeutic management of this uncommon entity is emphasized.

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A Case of Malignant Melanoma Presenting as a Breast Mass

Cited by 5 publications

References 0 publications

Concurrent BRAF and PTEN mutations in melanoma of unknown origin presenting as a breast mass

Concurrent BRAF and PTEN mutations in melanoma of unknown origin presenting as a breast mass

Breast Metastasis of a Completely Regressed Cutaneous Melanoma – Case Report and Review of Literature

Malignant melanoma of the breast: controversies in the diagnosis and therapeutic management of a rare nosologic entity

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