Amelanotic melanoma: a unique case study and review of the literature

Abstract

Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.

The Anticancer Potential of Doxycycline and Minocycline—A Comparative Study on Amelanotic Melanoma Cell Lines

“…One of the uncommon melanoma subtypes is amelanotic melanoma. The estimated incidence of amelanotic melanoma is about 2–8% of melanomas, but the real value can be higher due to misdiagnosis, mainly because of the lack of pigmentation [ 40 ]. The amelanotic subtype occurs usually in sun-exposed skin, especially in type I patients in the Fitzpatrick scale, and clinically manifests as red or pink-colored skin, erythematous macule or patch, or as a nodule with or without ulceration [ 41 , 42 ].…”

An angiomatous nodule of the cheek: What is your diagnosis?

“…However, the recent change and the atypical appearance on dermoscopy led to suspect a more invasive and to perform a biopsy in the next day, which was in favor of a nodular melanoma. Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment [1]. AM represents 2% to 20% of all melanomas.…”

“…It is thought to grow more rapidly than pigmented melanoma and to be associated with older age, freckling, and a sunsensitive phenotype. (2) The difficulty of diagnosis lies in the lack of pigment, therefore clinical criteria like the ABCDE algorithm cannot be applied in this case [1,2]. The most common form is the nodular variant, but any other clinicopathological form can be found [3].…”

Amelanotic melanoma of the head and neck: analysis of tumor characteristics from the National Cancer Database

“…To our knowledge, this retrospective study is the first to analyze the characteristics of AMHN and compare them with those of CMMHN. Clinically, AMHN can simulate other lesions, such as basal cell carcinoma, actinic keratosis, Bowen disease, keratoacanthomas, Merkel cell carcinoma, hemangiomas, pyogenic granulomas, and even dermatitis, 10,11 because of the lack of pigmentation and common visual characteristics 1 . Moreover, subtypes of melanoma, such as nodular, superficial lentigo malignant, and acral lentiginous melanoma, can also be amelanotic 11 .…”

“…Clinically, AMHN can simulate other lesions, such as basal cell carcinoma, actinic keratosis, Bowen disease, keratoacanthomas, Merkel cell carcinoma, hemangiomas, pyogenic granulomas, and even dermatitis, 10,11 because of the lack of pigmentation and common visual characteristics 1 . Moreover, subtypes of melanoma, such as nodular, superficial lentigo malignant, and acral lentiginous melanoma, can also be amelanotic 11 . The “ABCD” rule is not applicable for the recognition of AMHN as a consequence of its atypical appearance 12 .…”