Unusual Presentation of Giant Upper Limb Malignant Melanoma

Abstract

Melanoma is rare among the Asian population. In Malaysia, there is little public awareness of melanoma compared to other types of cancer. Giant melanomas measuring more than 10 cm are rarely encountered and there are limited data available regarding this disease. We would like to report an unusual presentation of giant malignant melanoma of upper limb in a 62-year-old patient who presented with a five-month history of a progressively enlarging, painless mass on his left arm. This mass which measures 10 x 15 cm turned out to be a giant malignant melanoma of the left arm. To our knowledge, this is the largest melanoma of arm reported in Malaysia. Radiological findings were suggestive of soft tissue sarcoma with lung metastasis. Patient underwent wide local excision of left-arm mass and upper limb reconstruction. The diagnosis of malignant melanoma was made based on the final histopathology report. Despite aggressive treatment involving multidisciplinary units, it did not prevent the disease progression and patient succumbed five months after his presentation. Here, we present our experience in the management of this large malignant melanoma of the arm and to stress the sinister nature of melanoma.

A Unique Case of Late Presentation Giant Lower Extremity Malignant Melanoma

“…Also unique to this case was the finding of a positive BRAF V600E mutation. BRAF mutations, while common in melanomas, were only found in two other cases of giant melanomas [ 4 , 5 ]. This genetic mutation, in a patient naive to systemic therapy, the patient’s functional status, and the metastatic nature of presentation, made treating with pembrolizumab an appropriate initial therapeutic option [ 14 - 16 ].…”

A rare presentation of a giant malignant melanoma in a 67 year old female Ugandan: A case report

“…A review study revealed that from 1960 to 2016, only 19 MM case reports had been published globally, and out of these, none were from Africa [ 10 ]. Of these, eight were on the trunk, six on the upper limb, four on the head, and only one on the lower limb (thigh) [ 1 , 10 , 11 ]. However, another evaluation of melanomas among Ethiopian patients 96 % predominance of nodular melanoma among 50 cases was described with only one case of Acral lentiginous melanoma from 1996 to 2005 [ 13 ].…”

“…Malignant melanoma is a neoplasm that develops from melanocytes [ 1 , 2 ]. In the earlier years, it was considered uncommon; however, reports show its incidence has increased, especially in the developed world [ 2 ].…”

“…Despite a considerably low prevalence, MMs are still a public health concern [ 4 , 5 ]. This is in part due to the slow progress and the delays in diagnosis, especially in low- and middle-income countries (LMICs) [ 1 ]. Melanomas can occur de novo on healthy skin or on pre-existing precursor lesions like common acquired nevus, dysplastic nevus, congenital nevus, and cellular blue nevus [ 5 , 6 ].…”

“…Melanomas can occur de novo on healthy skin or on pre-existing precursor lesions like common acquired nevus, dysplastic nevus, congenital nevus, and cellular blue nevus [ 5 , 6 ]. Factors associated with increased risk of development of MM include ultraviolet radiation, believed to be the main cause [ 5 ], genes including CDKN2A (p16), CDK4, RB1, CDKN2A (p19), PTEN/MMAC1, Ras, sunburn [ 1 ], and Parkinson's disease (PD), as recently reported in a retrospective case-control study in the Mayo Clinic among patients with PD and those with melanoma. Melanomas commonly occur at exposed sites.…”