Pigmented metastasis of breast carcinoma mimicking malignant melanoma

Abstract

Laugier-Hunziker syndrome (LHS) is a rare disorder characterized by melanotic pigmentation of the mouth and lips which is frequently associated with longitudinal melanonychia. Laugier and Hunziker described lenticular melanotic pigmentation of the oral cavity and lips in 1970. 1 Some cases have been described in which the neck, thorax, abdomen, fingers and soles have been involved. Fingernails are more frequently involved than the toenails. 2 Melanonychia may also be seen with or after lichen planus (LP). 3,4 We report a case of LHS associated with actinic LP.A 37-year-old Turkish woman was referred to our clinic with melanotic macules on the face, a pruritic annular plaque on the malar area of her face and hyperpigmented streaks on her nails, which had appeared for 19 years, 10 months and 6 years, respectively.Examination revealed the patient's pigmented macules on the lips, gums, buccal mucosa and midline of the hard palate ( fig. 1a). There were melasma and pinkish annular plaque, with a hyperpigmented centre ( fig. 1b). There were longitudinal melanonychia on her fingernails ( fig. 1c) and toenails. Hyperpigmented slate-grey to brown macular lesions were seen over her back. Examination of intertriginous areas did not reveal any evidence of acanthosis nigiricans. The skin phototype according to Fitzpatrick's scale was IV.Results of routine laboratory tests were within normal ranges, including triiodothyronine (T3), thyroxine (T4) and thyrotropin (TSH). The patient had smoked for 20 years. Her mother had melasma. Histopathological examination of pigmented macula on the buccal mucosa showed an accumulation of melanin in the cells of the basal layer of the acanthotic epidermis and an increased number of melanophages in the upper dermis ( fig. 2). Histopathologically, there was thinning of the epidermis with vacuolar alteration of the basal layer, an artifactural cleft between the epidermis and the lichenoid infiltrate and pigment incontinence in the upper dermis on the annular lesion over the cheek (fig. 3).Since the first description by Laugier and Hunziker, many cases of LHS have been reported. 2,[5][6][7] In this syndrome, the essential lesions are manifested as lenticular-pigmented macules, which have different colours (from grey to brown to blueblack) and a smooth surface. Generally symptoms are absent. The most common sites are the lips (especially the lower lip) and the oral cavity (buccal mucosa and hard palate). Other sites such as labial comissure, the gums the floor of the mouth and the tongue are less frequent. Other locations such as the abdomen and the fingers have been involved. Fingernail involvement can present as a single longitudinal 1-2-mm-wide streak or as a double 2-3-mm-wide longitudinal streak on the lateral parts of the nail plate, as a homogeneous pigmentation of the radial or ulnar half of the nail, and complete pigmentation of the nail. All four types of nail involvement may simultaneously involve one or more nails of the fingers and /or toes. 2 fig. 1 (a) Multiple pigmented macules lo...

Cutaneous Metastatic Breast Carcinoma with Melanocyte Colonization: A Clinical and Dermoscopic Mimic of Malignant Melanoma

“…McDivitt and coworkers 2 reported a heavily pigmented mammary carcinoma clinically confused for malignant melanoma. Similar cases of pigmented epidermotropic metastatic breast carcinoma have since been reported 3–8 . These rare pigmented cutaneous metastases represent a distinct clinicopathologic variant that may be a clinical and histopathologic mimic of malignant melanoma 9 …”

“…Similar cases of pigmented epidermotropic metastatic breast carcinoma have since been reported. [3][4][5][6][7][8] These rare pigmented cutaneous metastases represent a distinct clinicopathologic variant that may be a clinical and histopathologic mimic of malignant melanoma. 9 In addition to both primary and metastatic breast carcinoma, 10-13 melanin has been described in tumors other than melanocytic nevi or melanomas.…”

Non-melanocytic mimics of melanoma: Part I: intraepidermal mimics

“…The tumour cells in breast carcinoma are arranged in strands, cords and duct-like structures with melanocytes and melanophages interspersed among the tumour cells. The features that help to differentiate it from melanoma include the relative absence of junctional nesting and positive staining of the atypical cells for cytokeratin, EMA, CEA and GCDFP-15 39 40. On the other hand, melanocytic markers are usually negative in epidermotropic metastatic breast carcinoma 40…”

Melanoma‐like pigmented cutaneous metastasis of breast carcinoma

“…2 Because of the potential implications for prognosis and management, the early diagnosis of such lesions is crucial. [3][4][5][6][7] Here, we report a case of metastatic pigmented cutaneous breast carcinoma that mimics malignant melanoma both clinically and dermatoscopically. [3][4][5][6][7] Here, we report a case of metastatic pigmented cutaneous breast carcinoma that mimics malignant melanoma both clinically and dermatoscopically.…”

“…8 It metastasises most frequently to the chest and abdominal wall, close to the mastectomy scar. [3][4][5][6][7] To our knowledge, there have been very little data on the dermatoscopic findings of skin metastases, and the pigmented forms are one of the rarest. 2 Pigmented cutaneous metastasis of breast carcinoma is a rare clinical presentation that leads to difficulties differentiating from melanoma not only clinically and dermatoscopically but also histopathologically.…”