Advanced Pretibial Melanoma (APM): Clinicians Behaviour As Triggering Factor?

Abstract

Background: Pigmented lesions represent a broad spectrum of clinical conditions, both benign and malignant. The precise diagnosis is often a challenge, while the clinical diagnostic criteria could be misleading, as a result of the frequently atypical presentation of otherwise completely benign in nature lesions. The variety of therapeutic options for benign pigmented lesions including shave curettage, local laser destruction, electrocoagulation removal could sound enticingly both for the physician and patient, but they destroy the possibility for histological examination and provide a deceptively feeling of calm, that the problem is solved. If there is even a minimum chance for misdiagnosis, the risk could be a human life. Furthermore, a simple surgical excision could provide total resolution of the problem, with correct histological verification and further therapeutic measurements, if needed.

Case report: We present a case of a patient, with advanced pretibial melanoma with multiple lung metastases, misdiagnosed as a seborrheic keratosis, treated with shave-curettage 6 months earlier, as we want to emphasize the importance of the correct therapeutic method in all cases with pigmented lesions with unknown origin, in order to minimize the risk of dramatic consequences of misdiagnosis of melanoma. So, we want to ask you- is this risk justified?

Conclusion: So, we want to ask you - is this risk justified?

Keywords: imitation; melanoma; outcome; risk behaviour; seborrheic keratosis; surgery.

Figure 1

a,b – a Clinical manifestation of advanced pretibial melanoma, 6 months after shave curettage of the so-called “seborrheic keratosis”; 1c – Preoperative marking of the surgical safety margins; 1d, e, f, g – Intraoperative findings: Elliptic surgical excision under local anesthesia; 1h- Postoperative findings. Closing of the wound with single stitches