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Review
. 2018 Mar 29:2018:bcr2017222751.
doi: 10.1136/bcr-2017-222751.

Amelanotic melanoma: a unique case study and review of the literature

Katherine A Kaizer-Salk  1 , Robert J Herten  2 , Bruce D Ragsdale  3 , Roberta D Sengelmann  1   4
Affiliations
Review

Amelanotic melanoma: a unique case study and review of the literature

Katherine A Kaizer-Salk et al. BMJ Case Rep. .

Abstract

Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.

Keywords: cancer intervention; dermatology; general practice / family medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Initial biopsy. An atypical population of lower epidermal melanocytes with variable nuclear size and prominent nucleoli lack melanin pigment and show pagetoid rise above nevomelanocytes of an incidental underlying intradermal nevus lacking prominent nucleoli (×400).
Figure 2
Figure 2
Amelanotic melanoma presenting in a 72-year-old patient. Following only the initial punch biopsies, the left eyelid and cheek area appeared as a red scaly erythematous patch without melanin pigmentation.
Figure 3
Figure 3
Postoperative defect following the fifth stage of a seven-staged excision, measuring.
Figure 4
Figure 4
As reconstructed from the several specimens, the irregular outline of melanoma in situ is in black, set within the postoperative outlines of surgical stages 5 (green) and 6 (blue). The four focal sites of invasion are at letter positions: A = 0.42 mm, B = 1.30 mm, C = 0.22 mm and D = 0.35 mm. An incidental small papular intradermal nevus was at position E.
Figure 5
Figure 5
One week following repair with a full-thickness skin graft and laterally-based rhombic transposition flap.
Figure 6
Figure 6
Final result at 6 months following reconstruction.
See this image and copyright information in PMC

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