Nodular melanoma: A case report

Abstract

We report a case of nodular melanoma. A 46-year-old female presented with a brown papule on the medial side of the right upper arm for more than 40 years, with an increase in size for 2 months. Dermatological examination revealed a demarcated brown fungoid nodule with crusts, 1.3 cm in diameter, on the medial side of the right upper arm. The nodule was surrounded by light erythema, without ulceration. Histopathology showed exophytic nodular growth, involving both the epidermis (Paget's cells) and the reticular dermis. The tumor cells appeared in epithelioid or spindle shapes with abundant cytoplasm, vesicular nuclei of varying sizes, prominent nucleoli, and mitoses (4/HP), arranged in a nest pattern. Breslow thickness was 10 mm, and Clark level was Ⅳ. Immunohistochemistry demonstrated S-100 (diffuse+), Melan-A(+), HMB-45 (focal+), Ki-67 hot spot area(25%+), SOX-10 (diffuse+), and PRAME (diffuse+).The diagnosis of nodular melanoma was made. The patient underwent an extensive excision. The patient was recommended to seek medical care in other facility. The latest follow-up showed that surgery and chemotherapy were not given after evaluation by the oncology department at other hospital.

Keywords

• malignant
• melanoma
• nodular melanoma