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Case Reports
. 2021 Aug 1;13(8):e16819.
doi: 10.7759/cureus.16819. eCollection 2021 Aug.

Aggressive Nodular Malignant Melanoma

Daniel J Myers  1   2 , Ethan A Hyde  3
Affiliations
Case Reports

Aggressive Nodular Malignant Melanoma

Daniel J Myers et al. Cureus. .

Abstract

A subtype of malignant melanomas, nodular melanoma often carries a poor prognosis because of local invasion and frequent distant metastasis. Here, we report a case of progressive dyspnea due to one of the largest primary melanomas in the literature to date along with management strategies and elucidate some of the reasons why patients delay seeking care.

Keywords: breslow's depth; clark level; malignant; melanoma; nodular.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A large 17 × 17 × 6 cm exophytic mass of the left posterior torso consistent with nodular melanoma.
Figure 2
Figure 2. Contrast-enhanced CT image of the thorax. The mass is seen at the level of the scapula with superficial muscle compartment involvement. In addition, moderate pleural effusions and right basilar atelectasis are visualized.
CT: computed tomography
Figure 3
Figure 3. A left occipital lobe-enhancing solid mass measuring 1.5 × 1.7 cm with mild-to-moderate vasogenic edema is seen on axial T2 MRI of the brain.
MRI: magnetic resonance imaging
Figure 4
Figure 4. Biopsy of the mass confirming nodular melanoma with a Breslow thickness of 10.1 mm, Clark level IV, stage pT4b, mitotic rate of 3 mitoses/mm².
The mass was positive for MelanA (A), SOX-10 (B), and PRAME (C), but negative for BRAFV600.
Figure 5
Figure 5. PET-CT displaying disease metastasis to the bilateral axillary lymph nodes, lung, and left plantar bone.
PET-CT: positron emission tomography-computed tomography
See this image and copyright information in PMC

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