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Unilateral Unique Primary Melanomas
Tchernev G1, 2*, Chokoeva AA3
1Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
2University Hospital Lozenetz, Policlinic for Dermatology and Venereology, Sofia, Bulgaria
3"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
2University Hospital Lozenetz, Policlinic for Dermatology and Venereology, Sofia, Bulgaria
3"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
*Corresponding author: Associate Professor Georgi Tchernev, PhD, Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Koziak
street 1, 1407 Sofia, Bulgaria, Tel: +359 885 588 424; E-mail:
@
Received: December 19, 2015; Accepted: December 24, 2015; Published: December 27, 2015
Citation: Tchernev G, Chokoeva AA (2015) Unilateral Unique Primary
Melanomas. Clin Res Dermatol Open Access 2(3): 1-1. DOI: http://dx.doi.org/10.15226/2378-1726/2/3/00115
Description
We present a 68-year-old female patient, consulted on the
occasion of a pigment lesion at her left cheek with 7-8 years old
history. Clinical and dermatoscopically, the lesion corresponded
perfectly to the criteria for nodular malignant melanoma. The
performed imaging and serological diagnostics showed no
evidence of metastases. Within the clinical examination, our
attention was further drawn to the availability of additional
pigment lesion localized at the heel area - measuring 1 cm to 0.8
cm, symmetrical, with uniform color, clearly distinguished from
the healthy tissue, without evidence of elevation, which was
strongly suspected for superficial spreading melanoma (Figure
1a-c). A surgical eradication was planned with field of surgical
security of 1 cm in all directions.
Unilateral and multiple manifestation of heterogeneous type melanomas (nodular, superficial spreading melanoma, amelanotic melanoma, desmoplastic melanoma etc.) occurs more frequent in patients with FAMMM syndrome (familial or sporadic form) or hereditary melanoma [1, 2].
About 10% of all melanoma patients report a family history of melanoma; however, individuals with features of true hereditary melanoma (ie, unilateral lineage, multigenerational, multiple primary lesions, and early onset of disease) are in fact quite rare
Unilateral and multiple manifestation of heterogeneous type melanomas (nodular, superficial spreading melanoma, amelanotic melanoma, desmoplastic melanoma etc.) occurs more frequent in patients with FAMMM syndrome (familial or sporadic form) or hereditary melanoma [1, 2].
About 10% of all melanoma patients report a family history of melanoma; however, individuals with features of true hereditary melanoma (ie, unilateral lineage, multigenerational, multiple primary lesions, and early onset of disease) are in fact quite rare
Figure 1: a,b: Clinical manifestation of the nodular pigmented tumor
with uniform color, clearly distinguished from the healthy tissue, hightly
suspected for nodular malignant melanoma, located on the left cheek,
bellow os zygomaticus in 68-year-old female patient.
1c: Clinical manifestation of a superficial spreading melanoma, located
on the heel area of the left leg in the same patient.
[1]. Although many new loci have been implicated in hereditary
melanoma, CDKN2A mutations remain the most common
[1]. These patients have a high risk of developing multiple
primary melanomas and internal organ malignancies, especially
pancreatic cancer; therefore, a multidisciplinary approach
is necessary in many cases [1]. The value of dermoscopic
examination and total body photography performed at regular
intervals has been suggested by a number of studies, and should
therefore be considered for these patients and their first-degree
relatives [1,2].
The simultaneous, and furthermore, the unilateral location of heterogeneous types of melanomas in adult patients have been sporadically described in the literature, but it remains rare in general [3].
Regarding the newest investigations about the MPM (multiple primary melanomas) the risk of a subsequent melanoma decreased from 2% in the first year after diagnosis to a stable approximately 1% rate through 15 years of follow-up [4]. The risk of MPMs, although highest in the first year after diagnosis, remains stable thereafter [4].Those at highest risk of MPMs are older, male, white, and partnered [4]. Clinicians should be aware of the rate of MPMs and recognize high-risk subgroups [4].
The simultaneous, and furthermore, the unilateral location of heterogeneous types of melanomas in adult patients have been sporadically described in the literature, but it remains rare in general [3].
Regarding the newest investigations about the MPM (multiple primary melanomas) the risk of a subsequent melanoma decreased from 2% in the first year after diagnosis to a stable approximately 1% rate through 15 years of follow-up [4]. The risk of MPMs, although highest in the first year after diagnosis, remains stable thereafter [4].Those at highest risk of MPMs are older, male, white, and partnered [4]. Clinicians should be aware of the rate of MPMs and recognize high-risk subgroups [4].
- Soura E, Eliades PJ, Shannon K, Stratigos AJ, Tsao H. Hereditary melanoma: Update on syndromes and management: Genetics of familial atypical multiple mole melanoma syndrome. J Am Acad Dermatol. 2016;74(3):395-407. doi: 10.1016/j.jaad.2015.08.038.
- Tchernev G, Ananiev J, Cardoso JC, Chokoeva AA, Philipov S, Penev PK, et al. Multiple primary cutaneous melanomas in patients with FAMMM syndrome and sporadic atypical mole syndrome (AMS): what’s worse? Wien Med Wochenschr. 2014;164(15-16):302-307. doi: 10.1007/s10354-014-0295-8.
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- Moore MM, Geller AC, Warton EM, Schwalbe J, Asgari MM. Multiple primary melanomas among 16,570 patients with melanoma diagnosed at Kaiser Permanente Northern California, 1996 to 2011. J Am Acad Dermatol. 2015;73(4):630-636. doi: 10.1016/j.jaad.2015.06.059
