Melanoma in situ with in-transit metastases
Introduction: Melanoma in situ (MIS) is defined as the non-invasive precursor of malignant melanoma. It is widely considered to have no metastatic potential, and only few cases of metastasizing MIS have been reported. Presentation of case: We describe a case of a 57-year-old Danish female who presen...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-03-01
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| Series: | JPRAS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352587817300104 |
| _version_ | 1819050107449901056 |
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| author | Joachim Mikkelsen Anne Lene Hagen Wagenblast Nille Behrendt Jørgen Lock-Andersen |
| author_facet | Joachim Mikkelsen Anne Lene Hagen Wagenblast Nille Behrendt Jørgen Lock-Andersen |
| author_sort | Joachim Mikkelsen |
| collection | DOAJ |
| description | Introduction: Melanoma in situ (MIS) is defined as the non-invasive precursor of malignant melanoma. It is widely considered to have no metastatic potential, and only few cases of metastasizing MIS have been reported.
Presentation of case: We describe a case of a 57-year-old Danish female who presented with in-transit metastases 14 months after excision of cutaneous MIS on the left femur.
She had noticed two subcutaneous nodules develop over a short time proximal to the previous excision site. A needle biopsy and eventual complete excisional biopsy of both nodules confirmed the diagnosis of melanoma metastases. No further signs of metastases were found on additional imaging studies and the patient was assigned to the high-risk melanoma follow-up program.
Discussion: Of the few reported cases of metastasizing MIS, on review only three proved to be true MIS, defined by melanoma cells exclusively confined to the epidermis without dermal invasion through the basal membrane. Two of these had evident regression. Other studies of apparent metastatic MIS have revealed an invasive component on further sectioning of the specimens or by supplementary immunohistochemical staining.
Although areas of regression could represent a former invasive melanoma giving rise to metastases, this remains speculative. Theoretically, our patient could also have had an occult primary melanoma metastasizing to the skin, but no sign of this was demonstrated on a PET/CT scan.
Conclusion: Current treatment and follow-up guidelines for MIS do not recommend extensive surgery or frequent monitoring of patients, and upon diagnosis patients will routinely be told that there is no risk of metastases.
This case shows what is generally considered impossible – metastasizing melanoma in situ. The finding had severe implications for the patient, and raises the question of whether to intensify follow-up or the extent of surgery in patients with melanoma in situ, especially when regression is present. |
| first_indexed | 2024-12-21T11:42:47Z |
| format | Article |
| id | doaj.art-d8ecb53edf0f4267994895a8c4183d27 |
| institution | Directory Open Access Journal |
| issn | 2352-5878 |
| language | English |
| last_indexed | 2024-12-21T11:42:47Z |
| publishDate | 2017-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj.art-d8ecb53edf0f4267994895a8c4183d272022-12-21T19:05:15ZengElsevierJPRAS Open2352-58782017-03-0111C374210.1016/j.jpra.2017.01.006Melanoma in situ with in-transit metastasesJoachim Mikkelsen0Anne Lene Hagen Wagenblast1Nille Behrendt2Jørgen Lock-Andersen3Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Sygehusvej 10 4000 Roskilde, DenmarkDepartment of Plastic Surgery and Breast Surgery, Zealand University Hospital, Sygehusvej 10 4000 Roskilde, DenmarkDepartment of Histopathology, Zealand University Hospital, Sygehusvej 9 4000 Roskilde, DenmarkDepartment of Plastic Surgery and Breast Surgery, Zealand University Hospital, Sygehusvej 10 4000 Roskilde, DenmarkIntroduction: Melanoma in situ (MIS) is defined as the non-invasive precursor of malignant melanoma. It is widely considered to have no metastatic potential, and only few cases of metastasizing MIS have been reported. Presentation of case: We describe a case of a 57-year-old Danish female who presented with in-transit metastases 14 months after excision of cutaneous MIS on the left femur. She had noticed two subcutaneous nodules develop over a short time proximal to the previous excision site. A needle biopsy and eventual complete excisional biopsy of both nodules confirmed the diagnosis of melanoma metastases. No further signs of metastases were found on additional imaging studies and the patient was assigned to the high-risk melanoma follow-up program. Discussion: Of the few reported cases of metastasizing MIS, on review only three proved to be true MIS, defined by melanoma cells exclusively confined to the epidermis without dermal invasion through the basal membrane. Two of these had evident regression. Other studies of apparent metastatic MIS have revealed an invasive component on further sectioning of the specimens or by supplementary immunohistochemical staining. Although areas of regression could represent a former invasive melanoma giving rise to metastases, this remains speculative. Theoretically, our patient could also have had an occult primary melanoma metastasizing to the skin, but no sign of this was demonstrated on a PET/CT scan. Conclusion: Current treatment and follow-up guidelines for MIS do not recommend extensive surgery or frequent monitoring of patients, and upon diagnosis patients will routinely be told that there is no risk of metastases. This case shows what is generally considered impossible – metastasizing melanoma in situ. The finding had severe implications for the patient, and raises the question of whether to intensify follow-up or the extent of surgery in patients with melanoma in situ, especially when regression is present.http://www.sciencedirect.com/science/article/pii/S2352587817300104MelanomaMelanoma in situIn-transit metastasesRegressionFollow-upGuidelines |
| spellingShingle | Joachim Mikkelsen Anne Lene Hagen Wagenblast Nille Behrendt Jørgen Lock-Andersen Melanoma in situ with in-transit metastases JPRAS Open Melanoma Melanoma in situ In-transit metastases Regression Follow-up Guidelines |
| title | Melanoma in situ with in-transit metastases |
| title_full | Melanoma in situ with in-transit metastases |
| title_fullStr | Melanoma in situ with in-transit metastases |
| title_full_unstemmed | Melanoma in situ with in-transit metastases |
| title_short | Melanoma in situ with in-transit metastases |
| title_sort | melanoma in situ with in transit metastases |
| topic | Melanoma Melanoma in situ In-transit metastases Regression Follow-up Guidelines |
| url | http://www.sciencedirect.com/science/article/pii/S2352587817300104 |
| work_keys_str_mv | AT joachimmikkelsen melanomainsituwithintransitmetastases AT annelenehagenwagenblast melanomainsituwithintransitmetastases AT nillebehrendt melanomainsituwithintransitmetastases AT jørgenlockandersen melanomainsituwithintransitmetastases |