Malignant Melanoma of the Soft Parts Showing Calciphylaxis

Abstract

Calciphylaxis is a poorly understood and highly morbid syndrome of vascular calcification and skin necrosis. Hypercalcemia, hyperphosphatemia, and secondary hyperparathyroidism are the factors implicated in the pathogenesis of calciphylaxis, which is generally identified in patients with hyperparathyroidism secondary to end-stage renal disease. It has also been observed in primary hyperparathyroidism, end-stage liver disease, and rheumatoid arthritis, in the absence of renal disease. There are few case reports of calciphylaxis occurring in hypercalcemia of malignancy. An unusual case is reported of calciphylaxis associated with malignant melanoma of the soft parts in the absence of renal or parathyroid disease. This is the first reported case of this soft tissue sarcoma showing calciphylactic changes.

Calciphylaxis from Nonuremic Causes

“…Diabetes (26), chemotherapy-induced (cyclophosphamide, Adriamycin, and fluorouracil) protein C and S deficiency (18), Crohn disease (3), POEMS syndrome (12), vitamin D deficiency (10), weight loss (25), chronic kidney disease (not ESKD) (32), and osteomalacia treated with nadroparin calcium (8) were the remaining reported etiologic conditions. In 22 cases, corticosteroid use was an associated predisposing factor (3,6,7,12,13,20,21,23,28,30,33), warfarin use was reported in nine cases (5,6,31), albumin or blood transfusions were reported in seven cases (4,9,(12)(13)(14)(15)19), and protein C or S deficiency was reported in four cases (9,16,18,20). Precipitating trauma leading to cutaneous lesions was reported in only two cases (10,21).…”

“…The majority of the cases had normal serum calcium (58%), normal serum phosphorous (69.4%), normal calcium phosphorous product (72.2%), and low or normal serum parathyroid hormone levels (50%). Marked elevation in serum calcium (equivalent to Ͼ12 mg/dl) was seen in six cases (17,19,21,22,34), and marked serum phosphorous elevations were seen in only two cases (3,15). Elevation of calcium-phosphorous product Ͼ50 was seen in only seven cases (3,7,17,19,21,22,33).…”

“…In 22 cases, corticosteroid use was an associated predisposing factor (3,6,7,12,13,20,21,23,28,30,33), warfarin use was reported in nine cases (5,6,31), albumin or blood transfusions were reported in seven cases (4,9,(12)(13)(14)(15)19), and protein C or S deficiency was reported in four cases (9,16,18,20). Precipitating trauma leading to cutaneous lesions was reported in only two cases (10,21). Diabetes as an associated condition (not as a primary cause of NUC) was reported in eight cases (5,9,10,15,24,27,31).…”

“…Primary hyperparathyroidism (4,7,19,24,27,29,33), connective tissue diseases (6,20,28), alcoholic liver disease (9,11,13,14,16,22), and malignancies (5,15,17,21,23,30,31) were the most common causes of NUC (Table 1). Diabetes (26), chemotherapy-induced (cyclophosphamide, Adriamycin, and fluorouracil) protein C and S deficiency (18), Crohn disease (3), POEMS syndrome (12), vitamin D deficiency (10), weight loss (25), chronic kidney disease (not ESKD) (32), and osteomalacia treated with nadroparin calcium (8) were the remaining reported etiologic conditions.…”

“…These included 27 individual case reports (3,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32) and four case series (4,6,26,33). A summary of the literature search strategy is provided in Figure 1.…”