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Case Reports
. 2022 Jan 26:74:103316.
doi: 10.1016/j.amsu.2022.103316. eCollection 2022 Feb.

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria

Mohammed Moutaz Alshaghel  1 , Lana Almahairi  1 , Roua Arian  1 , Mohamad Shehab Alyousfi  1 , Weaam Majanni  2 , Rama Alyousfi  3 , Aladdin Etr  4
Affiliations
Case Reports

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria

Mohammed Moutaz Alshaghel et al. Ann Med Surg (Lond). .

Abstract

Introduction: and importance: Amelanotic melanoma is a rare and aggressive type of melanoma. It is often diagnosed late because of the lack of melanin in its cells, and this causes treatment delay and, eventually, poor prognosis.

Case presentation: We report a case of a 79-year-old female patient that presented to the dermatology clinic with an asymptomatic lesion on the medial heel of the right foot, with no medical history of previous melanoma or related skin cancer. To get the right diagnosis, an incisional biopsy was performed, and the sample was sent to the pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Also, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The patient was then referred to surgery. The lesion was successfully excised with 5cm safety margins, and the whole lesion was sent to the pathology laboratory to ensure that the edges are malignancy-free. After 18 months of follow-up, the patient is in good health.

Conclusion: Accurate and early diagnosis with appropriate clinical intervention can improve the prognosis and reduce mortality and morbidity rates.

Keywords: Amelanotic; Heel; Melanoma; Nodular; Surgical procedure.

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Figures

Fig. 1
Fig. 1
Clinical photograph showing asymptomatic mass with surgical safety margins.
Fig. 2
Fig. 2
Sections show ulcerated epidermis, the dermis show infiltration of malignant melanocytes that are highly pleomorphic, presence of prominent nucleoli and atypical mitotic figures. (A) Hematoxylin & eosin, X40. (B) Hematoxylin & eosin, X4.
Fig. 3
Fig. 3
(A) Immunohistochemistry for S100 (nuclear stain), is positive in tumor cells. (B) Immunohistochemistry for HMB-45 (cytoplasmic stain), is positive also.
Fig. 4
Fig. 4
Surgical eradiation of the mass with 5 cm safety margins.
Fig. 5
Fig. 5
Fixation of tie-over beads with sterile bandages.
Fig. 6
Fig. 6
Surgical site after 4 months of surgery.
Fig. 7
Fig. 7
Surgical site after 18 months of surgery.
See this image and copyright information in PMC

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