Bone marrow metastasis of malignant melanoma in childhood arising within a congenital melanocytic nevus

Abstract

Background. Malignant melanoma in childhood is infrequent and can arise within congenital melanocytic nevi. Spread of malignant melanoma to the bone marrow, especially in children, is extremely rare. Methods and Results. Reported is a case of a 5-year-old boy with a congenital large melanocytic nevus of the head and neck who presented with a short history of low back and leg pain, fever and cervical lymphadenopathy. Despite regular follow-up by a dermatologist and plastic surgeon and repeatedly negative histology of previous partial excisions, diffuse bone marrow infiltration with malignant melanoma was diagnosed. The primary site was identified in the post-excision area. The disease progressed rapidly on ipilimumab immunotherapy and led to death at four months from the diagnosis. Conclusion. Surveillance is indispensable in children with a predisposition to melanoma and nonspecific symptoms such as bone pain, gait impairment or cytopenia, should always be taken into account.

Bone marrow findings in metastatic melanoma, including role of BRAF immunohistochemistry

“…Other similar morphologic findings, included basophilic cytoplasm, cytoplasmic vacuoles, and prominent mitoses. All case series patients showed expected positivity for melanoma markers, including S100, HMB45, and Melan A, which was comparable to the literature that reported immunohistochemical staining results …”

Bone marrow metastases: a systematic review of a neglected involvement in malignant melanoma

“…1 and Table 1, respectively. The included studies were published from 1941 to date [1,2,4–74], with a peak between 2013 and 2023 (60%; 44/73).…”

“…In this comprehensive systematic review spanning from 1941 to 21 August 2023, we have meticulously analyzed a total of 73 studies encompassing 146 patients with BMM arising from melanoma with three additional cases of our institutions (San Raffaele Hospital, Milano and Papa Giovanni XXIII Hospital, Bergamo) [1,2,4–74]. Historically, bone marrow involvement in melanoma has been considered a relatively infrequent event, occurring in approximately 5–7% of cases [1,2].…”

“…Strikingly, bone marrow morphologic examination revealed the absence of pigmented melanocytes in 23% of cases, even when the primary site was pigmented. This percentage exceeds the prevalence of primary amelanotic melanoma (approximately 1–8% of all melanomas) [45,79–81].…”

Nevo melanocítico congénito gigante

“…La presencia de NMCG, a pesar de su carácter benigno, representa un factor de riesgo importante para el desarrollo de melanoma, principalmente en las primeras dos décadas de la vida, con un riesgo relativo de malignización de 52-1,000 veces mayor que el de la población general, y una edad media de presentación a los 14 años. El tamaño (≥ 20 cm), la presencia de nevos satélite, la hipertricosis, el aspecto nodular, la rugosidad o el color heterogéneo son características que por sí mismas aumentan el riesgo de malignidad, que se exacerba al existir antecedentes familiares de melanoma, exposición prolongada a la luz ultravioleta o inmunosupresión 8,13,23,24 .…”