Triple Synchronous Primary Melanomas in a 77-Year-Old Sea Captain: Importance of Total Skin Examination

Abstract

When it comes to skin diseases, melanomas are considered the most lethal. Triple synchronous primary melanomas (SPMs) are rare. Here we have reported a case of a 77-year-old white male with three SPMs. The patient presented with a nodular melanoma in the upper left back; total skin examination (TSE) revealed additional melanomas in the right retroauricular region and on the left arm. The patient was unaware of these two additional melanomas that were only found because of the routine TSE, and the index lesion focused examination would have missed both. We advocate that TSE should be practised routinely by all dermatologists for all new patients, and also, from time to time in patients attending long-term follow-up appointments. Early diagnosis means simpler treatments and more favourable outcomes.

Keywords: complete skin examination; diagonal ear lobe creases; dupuytren’s contracture; index lesion focused examination; multiple melanomas; multiple primary melanomas; synchronicity; synchronous melanomas; synchronous primary melanomas; total skin examination.

Figure 1. Nodular melanoma of the upper left back

It was ulcerated, with a diameter of at least 2 mm, Breslow thickness at least 4.9 mm, Clark level at least IV, mitotic rate 7 per mm², and microstaging pT4b.

Figure 2. Lentigo maligna/early invasive melanoma of the right retroauricular region

It had a Breslow thickness of 0.2 mm; the arrow points to the melanoma.

Figure 3. Melanoma of the left arm, in situ