A Rare Disease Presentation of Malignant Fungating Acral Melanoma of the Hand

Abstract

Malignant melanoma is relatively uncommon and accounts for 1%-3% of all malignant tumors. Malignant melanoma of the hand is exceptionally rare and highly malignant, with rapid progression if left untreated. Early clinical symptoms can be overlooked, and the tumor is often at a late stage when patients seek care, prompting amputation of the affected region. We present a case of a 48-year-old man who presented with a rapidly progressive, large, fungating mass of the distal aspect of the little finger diagnosed as malignant melanoma. We describe the presentation and treatment of this patient, who ultimately underwent partial amputation of the fifth metacarpal. Histologic analysis demonstrated nodular melanoma.

Keywords: Acral; Fungating; Hand; Malignant melanoma.

Figure 1

A A clinical image of the right little finger at initial presentation. B Radiographs of the right hand, with the anteroposterior view, C oblique view, and D lateral view demonstrating a soft-tissue mass of the little finger, with evidence of lytic lesions at the distal phalanx. There was an incidental finding of a previously healed proximal phalangeal base fracture, which appeared healed.

Figure 2

Radiographs of the right hand approximately 4 months from the initial presentation. A Anteroposterior view, B oblique view, and C lateral view demonstrating enlargement of the previous soft-tissue mass of the little finger, with evidence of lytic lesions at the distal phalanx and expansion into the middle phalanx.

Figure 3

Radiographs of the right hand approximately 10 months from the initial presentation. A Anteroposterior view and B lateral view demonstrating further enlargement of the soft-tissue mass of the little finger, with expansion into the middle phalanx and head of the proximal phalanx.

Figure 4

A clinical image of the right little finger at 10 months from the initial presentation. Gross images of the A dorsal surface and B volar surface.

Figure 5

Histology images of the mass of the right little finger. A Melanoma with skin ulceration (left) and focal heavy melanin pigmentation (lower right) (Hematoxylin-eosin stain; magnification × 12.5). B Melanoma cells, mainly spindle shaped, with the presence of dispersed melanin (Hematoxylin-eosin stain; magnification × 40). C Pleomorphic melanoma cells with melanin pigment (Hematoxylin-eosin stain; magnification × 100). D Brisk mitotic activity in melanoma (Hematoxylin-eosin stain; magnification × 400).

Figure 6

Postoperative radiographs of the right hand, with the A anteroposterior view, B oblique view, and C lateral view demonstrating successful amputation at the fifth metacarpal midshaft.