Intramammary metastatic melanoma of unknown primary origin in a 58-year old patient: a case report

Abstract

BackgroundMalignant melanoma metastasis to the breast is a rare disease.Case presentationWe present the case of a 58-year-old postmenopausal Caucasian woman with metastatic malignant melanoma of unknown origin of the right breast. She presented with a palpable lump in the inferior quadrant of her right breast. The investigations concluded it was breast metastasis from a malignant melanoma of unknown origin. The treatment consisted of mastectomy and axillary lymph node dissection. Two lymph nodes were positive for tumor cells and one showed extracapsular extension. Our patient did not receive immediate adjuvant therapy. Six weeks after the surgery, our patient presented a relapse in the right axilla (a 6 × 4 cm mass) with positive internal mammary lymph nodes and a single brain metastasis. This relapse motivated an adjuvant treatment with partial regression of the disease. Currently, our patient presents multiple metastases with poor prognosis.ConclusionsFrom this experience, we advocate an immediate aggressive handling of melanoma metastasis to the breast.

Malignant melanoma of the breast: controversies in the diagnosis and therapeutic management of a rare nosologic entity

“…7 Approximately 20% of patients with melanoma will develop metastases via hematogenic or lymphatic route. 11 Although metastatic disease to the breast is uncommon, melanoma comprises approximately 30% of all breast metastases. 8 The average age of women with metastatic melanoma of the breast is 39 years; therefore, most of them are premenopausal.…”

“…34 This explains the increased incidence of metastasis in premenopausal women, especially in the upper outer quadrant of the breast. 11,27 The interaction of metastatic cells with the microenvironment and immune system of the host is associated with the aggression of melanoma. 9 Metastatic melanocytes do not stimulate autologous peripheral blood lymphocytes (PBL) to proliferate and become cytotoxic, inhibiting the antitumor Melanoma is one of the most common sources of breast metastases, thus in a patient presenting with a breast mass and a primary melanotic lesion in a different place of the body, metastatic melanoma of the breast should always be part of the differential diagnosis.…”

“…29 On ultrasonography, nodules are typically round or oval and hypoechoic, with a well-defined posterior wall and occasionally increased vascularity, which can help differentiate them from a benign nodule. 11 On MRI depiction, lesions with high signal on T1-weighted and low signal on T2-weighted images set the suspicion of a melanin-containing tumor. 37 Maniglio et al 38 also reported very early uptake of contrast medium and a remarkably rapid washout on MRI.…”

“…29 Moreover, diagnosing a breast melanoma lesion merely through clinical examination and imaging is not possible, as it can appear with characteristics similar to other malignant or even benign breast neoplasms. 11 Therefore, histopathological examination combined with immunohistochemistry staining techniques is implemented in the diagnosis of primary or metastatic breast melanoma (Fig. 1).…”

“…9 Actually, the majority of fourth-stage skin melanoma patients begin with one metastatic site, namely the skin or the lung, while for metastatic tumors it depends on the specificities of the melanoma. 10,11 Adjuvant therapy is always mandatory for advanced PMMB or metastatic disease and depends on clinical evidence. The aim of this study is to meticulously review the literature of primary and metastatic malignant melanomas of the breast and report epidemiologic and clinicopathologic data for this rare entity.…”