Patient with giant upper limb melanoma presenting to a UK plastic surgery unit: differentials and experience of management

Abstract

A 57-year-old woman was referred to our regional sarcoma unit following a 2-year history of a progressively enlarging mass on her right forearm. At 14 × 7 × 12 cm, this mass turned out to be one of the largest upper limb cutaneous malignant melanomas ever described, and, to the best of our knowledge, the first documented in the UK. Remarkably, despite having a T4 malignant tumour with a Breslow thickness of 70 mm, this patient is still alive over 4 years later with no locoregional or distant metastatic spread. We present our experience in the management of this giant malignant melanoma of the upper limb and consider important differentials.

Figure 1

Large right forearm mass at time of presentation.

Figure 2

MRI showing large soft tissue mass at time of presentation.

Figure 3

Histopathology image showing stain for Melan-A (×200).

Figure 4

Right forearm 4 years after initial excision and SSG.