Cutaneous Melanoma Metastases Arising on a Split-Skin Graft Donor Site

Abstract

The authors have indicated no significant interest with commercial supporters.C utaneous metastases are a frequent event in the clinical course of malignant melanoma, accounting for more than 40% of the metastatic sites. 1 Skin involvement can represent an early and a late phase of melanoma progression and can occur as a loco-regional recurrence or as distant metastases.Not uncommonly, cutaneous metastases arise within the recipient skin graft at the site of the primary melanoma. Much rarer are metastases confined to a skin graft donor site. Only four cases of melanoma have been described, 2-5 and reports of other cancer histotypes are exceptionally rare. 6,7Here we describe a case of a patient with melanoma metastases developed in a split-thickness skin graft donor site as the first cutaneous sign of disseminated disease. Case ReportA primary ulcerated melanoma on the right supraclavicular region, 2.2 mm thick, Clark level IV, of a 40-year-old man was treated with surgical excision in July 2007. On October 2007, small multiple cutaneous metastases merging into a nodular lesion were localized on the surgical scar; a swelling of the right axillary lymph nodes was also present (Figure 1). The patient underwent radical node dissection associated with the excision of cutaneous metastases. The defect was repaired using a full-thickness skin graft (0.8 cm) taken with an electric dermatome from the patient's left thigh. The histological examination confirmed the presence of melanoma cells in the skin and in six of 30 axillary lymph nodes. One month later, multiple blackbluish papulonodular lesions, ranging from 1 to 10 mm in diameter, developed on the skin graft donor site, whereas contiguous areas were uninvolved ( Figure 2); similar lesions were also present in the supraclavicular engrafted site (Figure 3). Histological analyses confirmed the metastatic nature of the lesions. Computed tomography scan showed disseminated lung and liver involvement. Blood samples from this patient were positive for tyrosinase messenger RNA (mRNA) expression as tested using reverse transcriptase polymerase chain reaction (RT-PCR) technology. 8,9 Despite palliative chemoimmunotherapy performed with dacarbazine, cisplatin, vindesine, interleukin-2, and alpha-interferon, the patient died in 2 months. DiscussionTo our knowledge, cutaneous metastases of melanoma on a skin graft donor site have been described in four case reports. [2][3][4][5] In all of these patients, despite the unlikeness base on Breslow thickness, histotype, and site of primary melanoma, the disease

The cutaneous manifestations of metastatic malignant melanoma

“…The subsequent metastases may represent a reaction similar to Koebner phenomenon 17–20 . CMMMs have also appeared at sites of surgical trauma, which supports this hypothesis 18,21 . Others have suggested that the zosteriform spread of tumor cells may be due to enlarged lymphatics present at sites of infection 19,22 …”

“…[17][18][19][20] CMMMs have also appeared at sites of surgical trauma, which supports this hypothesis. 18,21 Others have suggested that the zosteriform spread of tumor cells may be due to enlarged lymphatics present at sites of infection. 19,22 The presentation of cutaneous metastatic melanoma may be eruptive.…”

Cutaneous Metastases from Malignant Melanoma: Clinical Features and New Therapeutic Perspectives

“…In these cases, clinical diagnosis could be more challenging and metastases can be suspicious for benign entities ( Figure 1). However, zosteriform metastases, as well as the rare skin metastases occurring on skin graft donor site, could be explained as a Koebner phenomenon , Marenco et al 2009.…”

Pigment Occurrence in Skin Graft Donor Sites

“…Melanoma metastases on skin graft donor sites have been described in five case reports . In these patients, the disease was aggressive, with early‐onset visceral metastasis.…”

“…In these patients, the disease was aggressive, with early‐onset visceral metastasis. With disease progression, metastases appeared near the primary tumor site and the skin graft donor site …”