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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4.	安文靜, 袁登榮. 原發性全脊柱惡性黑色素瘤1例. 臨床骨科雜志, 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, 匡遠黎. 肝臟原發性巨大惡性黑色素瘤1例. 嶺南現代臨床外科, 2022, 22(6): 588-591.
7.	張伊, 付其昌, 任翠萍, 等. 顱內原發性惡性黑色素瘤1例. 中國介入影像與治療學, 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, 郭貴龍. 惡性黑色素瘤伴乳腺轉移1例及文獻復習. 實用腫瘤雜志, 2007, (3): 257-258.
10.	陳勁果, 王仕欽, 朱禮樂, 等. 前列腺轉移性惡性黑色素瘤1例報告. 現代泌尿外科雜志, 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.	劉毅生, 沈家亮, 譚理連, 等. 非皮膚性惡性黑色素瘤的影像學表現. 中國CT和MRI雜志, 2012, 10(4): 101-105.
18.	沈愛琴, 凌偉江, 魏建國. 乳腺轉移性黑色素瘤冷凍切片誤診為浸潤性癌1例. 臨床與實驗病理學雜志, 2022, 38(10): 1269-1270.
19.	朱林江, 權毅. 乳腺惡性黑色素瘤5例臨床分析并文獻復習. 西南軍醫, 2013, 15(2): 217-219.
20.	趙萌, 何建坤, 劉月平. 乳腺轉移性無色素性上皮樣黑色素瘤6例臨床病理及分子遺傳學特征. 臨床與實驗病理學雜志, 2022, 38(11): 1309-1312.
21.	毛麗麗, 斯璐, 郭軍. 2020版CSCO黑色素瘤指南解讀. 中華轉移性腫瘤雜志, 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.	溫莉虹, 林瑞潑, 陳阿德, 等. CD117和Sox10在惡性黑色素瘤中的表達及意義. 溫州醫科大學學報, 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.	張俊, 杜宇, 楊洪秋, 等. 黑色素瘤與MAPK信號通路. 西南軍醫, 2017, 19(3): 282-284.
30.	李青蕓, 劉曉雯, 鄧昊, 等. 靶向Ras信號通路抑制劑在腫瘤治療中的研究進展. 中國細胞生物學學報, 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. 安文靜, 袁登榮. 原發性全脊柱惡性黑色素瘤1例. 臨床骨科雜志, 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, 匡遠黎. 肝臟原發性巨大惡性黑色素瘤1例. 嶺南現代臨床外科, 2022, 22(6): 588-591.
7. 張伊, 付其昌, 任翠萍, 等. 顱內原發性惡性黑色素瘤1例. 中國介入影像與治療學, 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, 郭貴龍. 惡性黑色素瘤伴乳腺轉移1例及文獻復習. 實用腫瘤雜志, 2007, (3): 257-258.
10. 陳勁果, 王仕欽, 朱禮樂, 等. 前列腺轉移性惡性黑色素瘤1例報告. 現代泌尿外科雜志, 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. 劉毅生, 沈家亮, 譚理連, 等. 非皮膚性惡性黑色素瘤的影像學表現. 中國CT和MRI雜志, 2012, 10(4): 101-105.
18. 沈愛琴, 凌偉江, 魏建國. 乳腺轉移性黑色素瘤冷凍切片誤診為浸潤性癌1例. 臨床與實驗病理學雜志, 2022, 38(10): 1269-1270.
19. 朱林江, 權毅. 乳腺惡性黑色素瘤5例臨床分析并文獻復習. 西南軍醫, 2013, 15(2): 217-219.
20. 趙萌, 何建坤, 劉月平. 乳腺轉移性無色素性上皮樣黑色素瘤6例臨床病理及分子遺傳學特征. 臨床與實驗病理學雜志, 2022, 38(11): 1309-1312.
21. 毛麗麗, 斯璐, 郭軍. 2020版CSCO黑色素瘤指南解讀. 中華轉移性腫瘤雜志, 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. 溫莉虹, 林瑞潑, 陳阿德, 等. CD117和Sox10在惡性黑色素瘤中的表達及意義. 溫州醫科大學學報, 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. 張俊, 杜宇, 楊洪秋, 等. 黑色素瘤與MAPK信號通路. 西南軍醫, 2017, 19(3): 282-284.
30. 李青蕓, 劉曉雯, 鄧昊, 等. 靶向Ras信號通路抑制劑在腫瘤治療中的研究進展. 中國細胞生物學學報, 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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