Giant scalp melanoma: a case report and review of the literature

Abstract

Introduction: Among malignant melanoma lesions, those occurring on the scalp and neck have a particularly poor prognosis. In this case report, we present the largest melanoma of the head and neck and one of the largest melanomas of any anatomic site reported in the literature to date.

Methods: The biopsy revealed left scalp melanoma with a Breslow's thickness of at least 14 mm, and final needle aspiration of lymphadenopathy was consistent with malignant melanoma. Preoperative staging was T4aN3Mx. Wide local excision with 3-cm margins was performed, which included excision of the left ear en-bloc, along with a selective left neck dissection. Reconstruction was performed with a Bilayer Wound Matrix (Integra, 311 Enterprise Drive, Plainsboro, New Jersey) and eventual thin split-thickness skin graft.

Results: Final pathology of the left scalp en-bloc excision was a 14.5 × 10.4 cm malignant melanoma, Breslow's thickness of 18 mm. Numerous lymph nodes were positive for melanoma as well. Final pathologic staging was determined to be T4b N3 M1, Stage IV. Later the patient underwent split-thickness skin graft placement on the left scalp acellular dermal matrix, which healed with complete graft take.

Discussion: This case report demonstrates a unique presentation of a giant melanoma. With few other cases reported for comparison, it appears our patient's prognosis is poor, despite treatment according to current guidelines.

Figure 1

The left scalp lesion upon initial presentation to our clinic.

Figure 2

The lesion at 20× magnification.

Figure 3

The lesion at 200× magnification.

Figure 4

Our patient with healed split-thickness skin graft over the resection defect.