Giant melanoma of the left thumb

Aggressive Nodular Malignant Melanoma

A subtype of malignant melanomas, nodular melanoma often carries a poor prognosis because of local invasion and frequent distant metastasis. Here, we report a case of progressive dyspnea due to one of the largest primary melanomas in the literature to date along with management strategies and elucidate some of the reasons why patients delay seeking care.

Giant acral melanoma on the left thumb of a korean patient

The 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 7.0x4.0x3.5 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 and depression

A 29-year-old female patient presented with a giant melanoma on the external side of the left arm and concomitant multiple visceral metastases. The patient also had major depression and had avoided a consultation despite the large size of the lesion, delaying the diagnosis and treatment of her melanoma, which as far as we know is the largest, primary cutaneous melanoma ever reported. Excision of the tumor was performed as a palliative treatment and she died 1 month later. Depression has been identified as a factor that can worsen the course of a disease, although in this case it could have been the direct consequence of the dermatologic process.

Giant cutaneous melanomas: evidence for primary tumour induced dormancy in metastatic sites?

Two patients with giant, 8 cm and 19 cm melanomas of the upper extremity, respectively, are presented and discussed. Both patients had neglected their tumours and sought medical attention only after the appearance of distressing symptoms (for example, bleeding). Palpable lymph nodes were found on physical examination but no evidence of distant metastases was noted on imaging studies despite such enormous primary tumours. Both patients underwent aggressive treatment, including complete surgical resection of the primary tumour and ipsilateral axillary lymph node dissection. One patient had no evidence of local recurrence, but developed metastatic disease at 6 months follow-up. The other patient developed local recurrence and distant metastases within 2 months of resection.