Melanoma of unknown primary with skeletal muscle metastasis. A case report

Abstract

Background: Melanoma is usually discovered from an irregular skin patch or a modification of a pre-existing patch. Cutaneous and lymph node metastases are common. Muscle metastasis are rare. We report a case of melanoma with infiltration of the gluteus maximus, which had normal dermatological examination.Case presentation: A 43-year-old man with no history of skin surgery was admitted with progressively worsening dyspnea. On admission, he presented with superior vena cava syndrome, painless cervical lymphadenopathy and a painful swelling in the right buttock. Skin and mucous membrane examination did not reveal any abnormal or suspicious lesions. The biology was limited to a C-reactive protein of 40 mg/L, a white blood cell count of 23 G/L and a lactate dehydrogenase level of 1705 U/L. The computed tomography scan showed several lymphadenopathies, compression of the superior vena cava and a tissue mass at the expense of the gluteus maximus. Cervical lymph node biopsy and cytopuncture of the gluteus maximus were consistent with a secondary melanoma location. A stage III melanoma of unknown primary origin associated with lymph node metastases and extension to the right gluteus maximus was suggested.Conclusions: Melanoma of unknown primary accounts for 3% of diagnosed melanomas. Diagnosis is difficult in the absence of a skin lesion. Patients are diagnosed with multiple metastases. Muscle involvement is unusual and may suggest a benign pathology. In this context, biopsy remains essential for diagnosis.