Sarcoidosis in Melanoma Patients: Case Report and Literature Review

Abstract

Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients-either following antineoplastic therapy or without systemic treatment-may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor-such as exposure to ultraviolet light-may play a role in their developing melanoma and sarcoidosis.

Keywords: cancer; cutaneous; malignancy; melanoma; sarcoid; sarcoidosis; solid tumors.

Figure 1

Distant (a) and close (b) views of a red-brown colored plaque involving the right antecubital fossa of a 54-year-old man. The lesion was later diagnosed as melanoma in situ.

Figure 2

Distant (a) and close (b) views of a scaly annular violaceous plaque on the left calf of a 54-year-old man. The lesion was later diagnosed as cutaneous sarcoidosis.

Figure 3

High magnification view of a sample of a lesion taken from the right antecubital fossa of a 54-year-old man. A broad proliferation of moderately atypical melanocytes arranged as both irregular-sized nests and single cells along the dermal-epidermal junction can be observed. [Hematoxylin and eosin; ×40].

Figure 4

High magnification view of a sample of a lesion taken from the right antecubital fossa of a 54-year-old man. Areas of contiguous single cell growth as well as a high level pagetoid spread are highlighted by Melanoma Antigen Recognized by T Cell 1 (MART-1) immunohistochemical staining. The pagetoid melanocytes stained negatively for cytokeratin Anion Exchanger Isoforms 1-3 (AE1/3). A small focus of bland-appearing nevoid melanocytes can also be seen in the superficial papillary dermis. [Melanoma Antigen Recognized by T Cell 1; ×40].

Figure 5

Low (a) and high (b) magnification views of the sarcoidal granuloma taken from the left calf of a 54-year-old man. Low magnification view (a) shows hyperplasia and hyperkeratosis in the overlying epidermis as well as a lichenoid lymphocytic infiltrate at the dermal-epidermal junction. Langerhans cells and spindle-shaped interstitial histiocytes can be observed in the high magnification view (b). [Hematoxylin and eosin; a = ×10, b = ×40].