Atypical malignant melanoma of the chest wall skin and breast: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YI Jinzhi ,  LÜ Qing

Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LÜ Qing, Email: lvqingwestchina@163.com

Keywords：

Malignant melanoma; surgery; therapy; sentinel lymph nodes; case report

DOI：

10.7507/1007-4848.202303061

Video：

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Malignant melanoma is a kind of highly malignant tumor, which mainly occurs in the skin, mucous membrane, and rarely in the breast. Here we reported a case of malignant melanoma in the chest wall skin with mammary metastasis. A sizable pigment spot on the skin of the thoracic region was found at the patient’s birth, existing for 50 years with quite atypical clinical manifestation. A nodule at 12 o’clock of the left breast was found by ultrasound four months ago, who was mistaken for a fibroadenoma. As a result, the patient received a minimally invasive excision of the breast lesion, after which the pathological report suggested malignant melanoma. By sharing this case, we aimed to discuss the diagnosis and treatment of this kind of atypical malignant melanoma in detail and provide some clinical experience.

Citation： YI Jinzhi, LÜ Qing. Atypical malignant melanoma of the chest wall skin and breast: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1660-1665. doi: 10.7507/1007-4848.202303061 Copy

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2.	Chan KK, Chan RC, Ho RS, et al. Clinical patterns of melanoma in Asians: 11-year experience in a tertiary referral center. Ann Plast Surg, 2016, 77(Suppl 1): S6-S11.
3.	Chi Z, Li S, Sheng X, Si L, et al. Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: A study of 522 consecutive cases. BMC Cancer, 2011, 25(11): 85.
4.	安文静, 袁登荣. 原发性全脊柱恶性黑色素瘤1例. 临床骨科杂志, 2022, 25(6): 907.
5.	Nakamae T, Kamei N, Tanaka N, et al. Primary spinal cord melanoma: A two-case report and literature review. Spine Surg Relat Res, 2022, 6(6): 717-720.
6.	付建, 匡远黎. 肝脏原发性巨大恶性黑色素瘤1例. 岭南现代临床外科, 2022, 22(6): 588-591.
7.	张伊, 付其昌, 任翠萍, 等. 颅内原发性恶性黑色素瘤1例. 中国介入影像与治疗学, 2021, 18(4): 254.
8.	Qin XS, Chen K, Wang Z, et al. Primary malignant melanoma of breast presenting as ulcerated nipple and breast lump: A rare case report. Asian J Surg, 2022, 45(5): 1210-1211.
9.	尤捷, 郭贵龙. 恶性黑色素瘤伴乳腺转移1例及文献复习. 实用肿瘤杂志, 2007, (3): 257-258.
10.	陈劲果, 王仕钦, 朱礼乐, 等. 前列腺转移性恶性黑色素瘤1例报告. 现代泌尿外科杂志, 2023, 28(1): 91-92.
11.	Hao M, Zhao G, Du X, et al. Clinical characteristics and prognostic indicators for metastatic melanoma: data from 446 patients in north China. Tumour Biol, 2016, 37(8): 10339-10348.
12.	Hoos A, Berho M, Blumencranz PW, et al. Giant cellular blue nevus of the anterior chest wall mimicking metastatic melanoma to the breast: A case report. J Surg Oncol, 2000, 74(4): 278-281.
13.	Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅱ. Sun exposure. Eur J Cancer, 2005, 41(1): 45-60.
14.	Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅰ. Common and atypical naevi. Eur J Cancer, 2005, 41(1): 28-44.
15.	Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅲ. Family history, actinic damage and phenotypic factors. Eur J Cancer, 2005, 41(14): 2040-2059.
16.	Zhang N, Wang L, Zhu GN, et al. The association between trauma and melanoma in the Chinese population: A retrospective study. J Eur Acad Dermatol Venereol, 2014, 28(5): 597-603.
17.	刘毅生, 沈家亮, 谭理连, 等. 非皮肤性恶性黑色素瘤的影像学表现. 中国CT和MRI杂志, 2012, 10(4): 101-105.
18.	沈爱琴, 凌伟江, 魏建国. 乳腺转移性黑色素瘤冷冻切片误诊为浸润性癌1例. 临床与实验病理学杂志, 2022, 38(10): 1269-1270.
19.	朱林江, 权毅. 乳腺恶性黑色素瘤5例临床分析并文献复习. 西南军医, 2013, 15(2): 217-219.
20.	赵萌, 何建坤, 刘月平. 乳腺转移性无色素性上皮样黑色素瘤6例临床病理及分子遗传学特征. 临床与实验病理学杂志, 2022, 38(11): 1309-1312.
21.	毛丽丽, 斯璐, 郭军. 2020版CSCO黑色素瘤指南解读. 中华转移性肿瘤杂志, 2020, 3(2): 81-82.
22.	Thompson JF, Haydu LE, Uren RF, et al. Preoperative ultrasound assessment of regional lymph nodes in melanoma patients does not provide reliable nodal staging: Results from a large multicenter trial. Ann Surg, 2021, 273(4): 814-820.
23.	Weber P, Arnold A, Hohmann J. Comparison of 18F-FDG PET/CT and ultrasound in staging of patients with malignant melanoma. Medicine (Baltimore), 2022, 101(42): e31092.
24.	Dinnes J, Ferrante di Ruffano L, Takwoingi Y, et al. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database Syst Rev, 2019, 7(7): CD012806.
25.	温莉虹, 林瑞泼, 陈阿德, 等. CD117和Sox10在恶性黑色素瘤中的表达及意义. 温州医科大学学报, 2017, 47(3): 197-200.
26.	Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): A multicentre, randomised, phase 3 trial. Lancet Oncol, 2016, 17(6): 757-767.
27.	Broman KK, Hughes T, Dossett L, et al. Active surveillance of patients who have sentinel node positive melanoma: An international, multi-institution evaluation of adoption and early outcomes after the Multicenter Selective Lymphadenectomy Trial Ⅱ (MSLT-2). Cancer, 2021, 127(13): 2251-2261.
28.	Downs JS, Subramaniam S, Henderson MA, et al. A survey of surgical management of the sentinel node positive melanoma patient in the post-MSLT2 era. J Surg Oncol, 2021, 124(8): 1544-1550.
29.	张俊, 杜宇, 杨洪秋, 等. 黑色素瘤与MAPK信号通路. 西南军医, 2017, 19(3): 282-284.
30.	李青芸, 刘晓雯, 邓昊, 等. 靶向Ras信号通路抑制剂在肿瘤治疗中的研究进展. 中国细胞生物学学报, 2022, 44(3): 469-476.
31.	Zaman A, Wu W, Bivona TG. Targeting oncogenic BRAF: Past, present, and future. Cancers (Basel), 2019, 11(8): 1197.
32.	Long GV, Stroyakovskiy D, Gogas H, et al. Dabrafenib and trametinib versus dabrafenib and placebo for Val600 BRAF-mutant melanoma: A multicentre, double-blind, phase 3 randomised controlled trial. Lancet, 2015 , 386(9992): 444-451.
33.	Luke JJ, Rutkowski P, Queirolo P, et al. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage ⅡB or ⅡC melanoma (KEYNOTE-716): A randomised, double-blind, phase 3 trial. Lancet, 2022, 399(10336): 1718-1729.
34.	Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage Ⅲ melanoma. N Engl J Med, 2018, 378(19): 1789-1801.
35.	Robert C, Schachter J, Long GV, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med, 2015, 372(26): 2521-2532.
36.	Bhave P, Ahmed T, Lo SN, et al. Efficacy of anti-PD-1 and ipilimumab alone or in combination in acral melanoma. J Immunother Cancer, 2022, 10(7): e004668.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Chan KK, Chan RC, Ho RS, et al. Clinical patterns of melanoma in Asians: 11-year experience in a tertiary referral center. Ann Plast Surg, 2016, 77(Suppl 1): S6-S11.
3. Chi Z, Li S, Sheng X, Si L, et al. Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: A study of 522 consecutive cases. BMC Cancer, 2011, 25(11): 85.
4. 安文静, 袁登荣. 原发性全脊柱恶性黑色素瘤1例. 临床骨科杂志, 2022, 25(6): 907.
5. Nakamae T, Kamei N, Tanaka N, et al. Primary spinal cord melanoma: A two-case report and literature review. Spine Surg Relat Res, 2022, 6(6): 717-720.
6. 付建, 匡远黎. 肝脏原发性巨大恶性黑色素瘤1例. 岭南现代临床外科, 2022, 22(6): 588-591.
7. 张伊, 付其昌, 任翠萍, 等. 颅内原发性恶性黑色素瘤1例. 中国介入影像与治疗学, 2021, 18(4): 254.
8. Qin XS, Chen K, Wang Z, et al. Primary malignant melanoma of breast presenting as ulcerated nipple and breast lump: A rare case report. Asian J Surg, 2022, 45(5): 1210-1211.
9. 尤捷, 郭贵龙. 恶性黑色素瘤伴乳腺转移1例及文献复习. 实用肿瘤杂志, 2007, (3): 257-258.
10. 陈劲果, 王仕钦, 朱礼乐, 等. 前列腺转移性恶性黑色素瘤1例报告. 现代泌尿外科杂志, 2023, 28(1): 91-92.
11. Hao M, Zhao G, Du X, et al. Clinical characteristics and prognostic indicators for metastatic melanoma: data from 446 patients in north China. Tumour Biol, 2016, 37(8): 10339-10348.
12. Hoos A, Berho M, Blumencranz PW, et al. Giant cellular blue nevus of the anterior chest wall mimicking metastatic melanoma to the breast: A case report. J Surg Oncol, 2000, 74(4): 278-281.
13. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅱ. Sun exposure. Eur J Cancer, 2005, 41(1): 45-60.
14. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅰ. Common and atypical naevi. Eur J Cancer, 2005, 41(1): 28-44.
15. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: Ⅲ. Family history, actinic damage and phenotypic factors. Eur J Cancer, 2005, 41(14): 2040-2059.
16. Zhang N, Wang L, Zhu GN, et al. The association between trauma and melanoma in the Chinese population: A retrospective study. J Eur Acad Dermatol Venereol, 2014, 28(5): 597-603.
17. 刘毅生, 沈家亮, 谭理连, 等. 非皮肤性恶性黑色素瘤的影像学表现. 中国CT和MRI杂志, 2012, 10(4): 101-105.
18. 沈爱琴, 凌伟江, 魏建国. 乳腺转移性黑色素瘤冷冻切片误诊为浸润性癌1例. 临床与实验病理学杂志, 2022, 38(10): 1269-1270.
19. 朱林江, 权毅. 乳腺恶性黑色素瘤5例临床分析并文献复习. 西南军医, 2013, 15(2): 217-219.
20. 赵萌, 何建坤, 刘月平. 乳腺转移性无色素性上皮样黑色素瘤6例临床病理及分子遗传学特征. 临床与实验病理学杂志, 2022, 38(11): 1309-1312.
21. 毛丽丽, 斯璐, 郭军. 2020版CSCO黑色素瘤指南解读. 中华转移性肿瘤杂志, 2020, 3(2): 81-82.
22. Thompson JF, Haydu LE, Uren RF, et al. Preoperative ultrasound assessment of regional lymph nodes in melanoma patients does not provide reliable nodal staging: Results from a large multicenter trial. Ann Surg, 2021, 273(4): 814-820.
23. Weber P, Arnold A, Hohmann J. Comparison of 18F-FDG PET/CT and ultrasound in staging of patients with malignant melanoma. Medicine (Baltimore), 2022, 101(42): e31092.
24. Dinnes J, Ferrante di Ruffano L, Takwoingi Y, et al. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database Syst Rev, 2019, 7(7): CD012806.
25. 温莉虹, 林瑞泼, 陈阿德, 等. CD117和Sox10在恶性黑色素瘤中的表达及意义. 温州医科大学学报, 2017, 47(3): 197-200.
26. Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): A multicentre, randomised, phase 3 trial. Lancet Oncol, 2016, 17(6): 757-767.
27. Broman KK, Hughes T, Dossett L, et al. Active surveillance of patients who have sentinel node positive melanoma: An international, multi-institution evaluation of adoption and early outcomes after the Multicenter Selective Lymphadenectomy Trial Ⅱ (MSLT-2). Cancer, 2021, 127(13): 2251-2261.
28. Downs JS, Subramaniam S, Henderson MA, et al. A survey of surgical management of the sentinel node positive melanoma patient in the post-MSLT2 era. J Surg Oncol, 2021, 124(8): 1544-1550.
29. 张俊, 杜宇, 杨洪秋, 等. 黑色素瘤与MAPK信号通路. 西南军医, 2017, 19(3): 282-284.
30. 李青芸, 刘晓雯, 邓昊, 等. 靶向Ras信号通路抑制剂在肿瘤治疗中的研究进展. 中国细胞生物学学报, 2022, 44(3): 469-476.
31. Zaman A, Wu W, Bivona TG. Targeting oncogenic BRAF: Past, present, and future. Cancers (Basel), 2019, 11(8): 1197.
32. Long GV, Stroyakovskiy D, Gogas H, et al. Dabrafenib and trametinib versus dabrafenib and placebo for Val600 BRAF-mutant melanoma: A multicentre, double-blind, phase 3 randomised controlled trial. Lancet, 2015 , 386(9992): 444-451.
33. Luke JJ, Rutkowski P, Queirolo P, et al. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage ⅡB or ⅡC melanoma (KEYNOTE-716): A randomised, double-blind, phase 3 trial. Lancet, 2022, 399(10336): 1718-1729.
34. Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage Ⅲ melanoma. N Engl J Med, 2018, 378(19): 1789-1801.
35. Robert C, Schachter J, Long GV, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med, 2015, 372(26): 2521-2532.
36. Bhave P, Ahmed T, Lo SN, et al. Efficacy of anti-PD-1 and ipilimumab alone or in combination in acral melanoma. J Immunother Cancer, 2022, 10(7): e004668.

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