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

Abstract

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.

Rare Breast Cancer: Primary Melanoma of Breast Parenchyma

“…Sarcomatoid carcinoma and sarcoma with epithelioid features, like clear cell melanocytes, with unpredictable biological behavior. Typically, melanoma arises from the skin, and about 4-5% of primary lesions are extracutaneous [3]. It can be found in paranasal sinuses, anus and other mucosal linings (mucosal melanoma) as well as in the eye (uveal melanomas of the choroid, iris and ciliary body).…”

Diffusion‐Weighted Imaging Combined with Perfusion‐Weighted Imaging under Segmentation Algorithm in the Diagnosis of Melanoma

“…U represented the 3D image to be segmented in the equation (3). k � exp(−c|∇U| 2 ) was the surface feature map related to the 3D image gradient, c was the control slope, W(ϕ) was the Heaviside function, Ω was the 3D image area, and α and β were the predefined weights to balance the two items.…”

“…It usually occurs in skin, mucous membranes, and organs, but it can also occurs in the eyes, nasal cavity, and the brain sometimes. It can be newly caused by dysplastic nevus, and the malignant transformation of junctional nevus and congenital or acquired benign melanocytic nevus, accounting for about 3% of all tumors [ 2 , 3 ]. Signs of malignant transformation are generally manifested as the increase of the pigment volume, the darkening of the color, the sudden growth, and the appearance of inflammation, ulcers, and bleeding of the nevus [ 4 ].…”

Clinical evidence, diagnostic approach and challenging therapeutic modalities for malignant melanoma of the anorectum

“…An alternative option in patients with BRAF V600 mutations is the targeted therapy with a BRAF inhibitor (vemurafenib, dabrafenib, encorafenib) alone or in combination with a MEK inhibitor (cobimetinib, trametinib or binimetinib, respectively) 10 . Despite the absence of randomized trials regarding the effect of ipilimumab on mucosal melanoma, a retrospective analysis among 33 patients with unresectable or metastatic mucosal melanoma treated with ipilimumab suggested encouraging response rates 35–37 . Furthermore, in a large analysis of data for anti‐programmed death‐1 therapy in mucosal melanoma, nivolumab combined with ipilimumab seemed to have greater efficacy than each agent alone, and although the activity was lower in mucosal melanoma, the safety profile was similar between subtypes 38 .…”