Management of melanoma metastasis to the breast: case series and review of the literature

Abstract

Background: Metastases to the breast from extramammary cancers are rare; melanoma is one of the malignancies that can metastasize to the breast.

Objectives: To examine the records of a series of patients with a previous diagnosis of melanoma and a metastasis to the breast, and review the published literature of this condition.

Methods: We report details of eight female patients with breast metastases from melanoma seen over a 36-month period from 2001. All patients were female aged 28-84 years (median 58). The breast lump was investigated by core-cut biopsy or fine needle aspiration, with or without a mammogram.

Results: The time between diagnosis of the primary melanoma and the occurrence of a breast metastasis ranged from 13 to 180 months (median 62). In three patients the breast lump was the first sign of recurrence of melanoma. In three patients melanoma had previously relapsed in regional lymph nodes and in two patients it had already relapsed as locoregional and distant subcutaneous metastases before metastasizing to the breast. In two patients presenting via the breast clinic, the lump was subsequently confirmed on excision to be melanoma in an intramammary lymph node. In seven patients, a lumpectomy was performed after histological confirmation; one of these also had a level 1-3 axillary dissection. The eighth patient deteriorated clinically before further surgery was possible. Six patients developed further metastases within 1-5 months of breast lump detection. In one case a second 9 mm breast lump in the deeper tissue of the same breast was detected on a computed tomography scan and has been removed using stereotactic surgery. Four patients have died.

Conclusions: Presentation is usually with a palpable mass without skin changes. Investigation must include histology or cytology to confirm the diagnosis. Management of melanoma metastasis to the breast is discussed; in this series it was surgical unless there were many metastases.