Widespread finger skin metastases of melanoma.

Metastatic melanoma is a fatal disease with a rapid systemic dissemination. Almost every organ might be affected, but lungs, liver, bone, brain, and skin are the most frequently involved sites. Intravascular microtumoral embolism is believed to account for the distant cutaneous metastases that might be the first manifestation of disease progression in most of the cases.

Case Description

A 69‐year‐old woman with metastatic melanoma presented to our institute. In March 2013, a primary melanoma lesion located on her right deltoid region was excised, and sentinel lymph node biopsy was undertaken. She was staged as IIB; thus, she did not receive adjuvant immunotherapy (INF‐α2b) and she was taken in the standard follow‐up protocol. In February 2015, the PET/CT scan showed an extensive metastatic dissemination involving multiple sites, such as skin, subcutaneous tissues, lymph nodes, lungs, adrenal gland, and bones. Additionally, numerous cutaneous lesions developed on skin of her fingers (Fig. 1). The patient died within days before any therapeutic intervention commenced.

Figure 1

Widespread metastatic lesions on skin of her fingers.

Metastatic melanoma is a fatal disease with a rapid systemic dissemination with a 5‐year survival rate <15% 1. Only 4% of newly diagnosed melanoma patients present with distant metastasis at initial diagnosis. But, the majority of the patients –even if they present with early stage –are expected to develop metastatic disease eventually as a natural course of disease progression 1. Approximately, one‐third of all patients with melanoma will experience disease recurrence. Almost all organs can be involved; the most frequent target sites are the lungs, liver, bone, brain, and skin 1, 2, 3. Cutaneous metastases of melanoma develop as the first manifestation of disease progression in 56% of patients 2. However, 28% of skin metastases develop after lymph node involvement, 3% occur after visceral dissemination, and 12% coincide with lymph node and/or visceral involvements. Furthermore, intravascular microtumoral embolism has been incriminated for the development of the cutaneous metastases.

Conflict of Interest

None declared.

Authorship

FT and KE: have made substantial contribution to the preparation of this manuscript, involved in the conceptualization, preparation, writing, and review of this manuscript.