Giant Acral Melanoma on the Left Thumb of a Korean Patient

Abstract

Department of Dermatology, College of Medicine, Korea University, Seoul, KoreaThe acral regions of the limbs of Asians are predisposed to develop malignant melanoma, but giant-sized acral melanoma has not been previously reported in the Asian population. Giant-sized melanoma implies aggressive tumor invasion and so it is more difficult to achieve a therapeutic cure. A 56-year-old woman presented with a giant acral melanoma of the left thumb with concomitant bone destruction and axillary lymph node metastasis. The initial lesion was a subungual black macule on the left thumb that had grown into a giant 7.0×4.0×3.5 cm-sized melanoma over a 3 year period. The left thumb was amputated and the axillary lymph nodes were completely dissected. During the ensuing 3 months, she underwent adjuvant treatment with interferon-alpha-2a. The interesting feature of this case is that the large melanoma mass of this patient, which was accompanied with adjacent bone destruction and lymph node metastasis, had developed rapidly from a small black macule in the nail matrix, and this black macule was suspected to be a subungual melanoma.

Giant melanoma of the abdomen: case report and revision of the published cases

“…There does not appear to be a sex prevalence; 8 cases occurring in both males and females have been described. The most common location is the back [5][6][7][8][9], followed by scalp [1,10,11], upper arm [2,12], thumb [4,14], abdomen (our patient and 14), and eyelid [15]. Most cases did not show any precursor lesion (de novo onset), but in two patients melanoma arose in a congenital melanocytic nevus [5,8] and in another two patients it developed from a previously acquired melanocytic nevus [12,15].…”

“…Giant melanoma has rarely been described in the literature because patients usually come for treatment earlier, and practitioners are well aware of the catastrophic consequences of neglecting such tumors [4]. A systematic literature review, limited to the English language, has shown only 16 patients with melanoma appearing as a giant cutaneous tumor (Table 1).…”

Giant melanoma of the scalp - discussion of a rare clinical presentation

“…In majority of the cases, patients consult dermatologists or practitioners not because of the tumour itself, but because of pain, the lack of an appropriate piece of clothing or decoration (eg, watches) to cover it up, as in our case because of itching and weeping 2 3. Other cases suggested that underlying diseases, for example, depression can worsen the prognosis because of delayed diagnosis 4.…”

Acrometastasis as the initial presentation of bronchogenic carcinoma

“…In addition, subungual and giant acral melanomas may present as ulcerating lesions on the thumb with bony lytic involvement. 10 Finally, a fungating thumb lesion is very rarely the chief complaint of an undiagnosed lung cancer as was the case with our patient, making acrometastasis hard to suspect and therefore difficult to diagnose.…”