Sentinel bruising as a presentation of metastatic melanoma

Abstract

A 46-year-old man presented with a 4-week history of bruising with subcutaneous nodules and weight loss. He also had a 2-week history of progressive back and hip pain. He had been diagnosed with stage Ib cutaneous melanoma 30 months previously, which had been fully excised. A sentinel lymph node biopsy was negative. On examination, there were five skin lesions at different stages. Each had spontaneously appeared as a bruise with a central subcutaneous nodule, and the bruising then faded to leave a persistent subcutaneous nodule. Excision of one of the nodules demonstrated a 4.5 mm diameter partly necrotic melanoma deposit in the dermis. CT scan of the head, chest, abdomen and pelvis showed widespread metastases. This rare presentation of cutaneous malignant melanoma metastases has been termed ‘sentinel bruising’. There are fewer than 10 cases reported in the literature.

Hematoma‐like metastases in melanoma: Ultrasound findings

“…I G U R E 1 A-C, Clinical aspect of three hematoma-like cutaneous metastases of melanoma on the thorax and abdomen of the patient (black arrows); D-F, respective ultrasound images, showing well-defined hypoechoic nodules in the subcutaneous tissue (white arrows) [Colour figure can be viewed at wileyonlinelibrary.com]The reason for the infiltrating tumor cells causing bruising is currently not known: Some studies have proposed a role of aberrant angiogenesis and rupture of native vessels 4. Hematoma-like metastases of melanoma can be a sign of aggressive disease.…”