Ann Dermatol.  2014 Oct;26(5):628-631. 10.5021/ad.2014.26.5.628.

Epidermotropic Metastatic Melanoma Clinically Resembling Agminated Spitz Nevi

• Kim HJ
• So BJ
• You MG
• Kim IH

• KMID: 2265502
• DOI: http://doi.org/10.5021/ad.2014.26.5.628

Abstract

Herein, we report a 36-year-old Asian male patient who presented with grouped multiple erythematous waxy papules and nodules on his right medial thigh. He had undergone amputation of the right second toe because of a stage IIa malignant melanoma, 3 years previously. At the time of surgery for the primary tumor, right inguinal lymph node dissection revealed no nodal involvement. Three years after the diagnosis of the primary tumor, crops of multiple erythematous papules and nodules developed. Initial histopathologic evaluation of the papules showed nests of small epithelioid cells similar to compound nevi. However, cytologic features, including high mitotic figures, lack of maturation, and some hyperchromatic nuclei suggested metastatic melanoma. In addition to the pathologic findings, the tumors were on the right thigh, which was the same side as the primary malignant melanoma. The patient underwent wide excision of the tumor and split-thickness skin grafting.

Keyword

Epidermotropic metastatic malignant melanoma

MeSH Terms

Adult
Amputation
Asian Continental Ancestry Group
Diagnosis
Epithelioid Cells
Humans
Lymph Node Excision
Male
Melanoma*
Nevus*
Skin Transplantation
Thigh
Toes

Figure

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  Fig. 1 Multiple erythematous waxy papules and nodules on the right medial thigh (insert: close-up view).

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  Fig. 2 (A) Scanning view showing a well-circumscribed symmetric dome-shaped nodule comprising various-sized nests of tumor cells (H&E, ×12). (B) Epidermal tumor nests and single cell exhibiting pagetoid spread throughout the epidermis (H&E, ×40). (C) Tumor cells exhibiting epithelioid morphology, with monotonous and hyperchromatic nuclei, and loss of maturation (H&E, ×100). (D) Atypical mitoses in the epidermis (H&E, ×200). (E) Atypical mitoses in the dermis (H&E, ×200). (F) Atypical tumor cell nests and individual cells around blood vessels and inside vessel lumens, indicating angiotropism (H&E, ×200).

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  Fig. 3 Immunohistochemical analysis. (A) Ki-67 index <5%; (B) p53, (C) HMB-45, and (D) Cyclin D1 are focally positive on the superficial dermis; (E) p16 is only sparsely positive throughout the lesion; (F) Melan-A and (G) Bcl-2 are diffusely positive in the lesion (×100). HMB-45: human melanoma black-45.

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