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G. Ferrara, G. Sarracco, A. Erbazzi, G. Argenziano, F. Cusano, Lymphatic spread of melanoma mimicking Kaposi‐like angiodermatitis, British Journal of Dermatology, Volume 149, Issue 4, 1 October 2003, Pages 909–910, https://doi.org/10.1046/j.1365-2133.2003.05692.x
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Sir, We describe a highly unusual type of metastatic spread of melanoma to the skin through lymphadenectomy‐impaired lymphatic vessels. These metastatic deposits, when presenting solely with flat (macular) lesions, can simulate Kaposi‐like acroangiodermatitis.
A 73‐year‐old woman was seen for progressive enlargement of the left leg and thigh; oedema had been slowly developing for 2 years after inguinal lymphadenectomy for nodal metastasis of acral lentiginous melanoma of the left sole. The primary lesion (Clark level IV; Breslow thickness 3·3 mm; ulcerated) had been excised 3 years before inguinal metastases had been detected. On examination, the involved leg and thigh showed areas of bluish colour with a finely reticular pattern (Fig. 1a). The lesions also showed a brown hue in some areas. The patient reported that the pigmentation had been gradually enlarging for the last month.
Skin biopsy showed, within both the superficial and the deep dermis, widened lymphatic spaces filled with highly atypical pigmented cells (Fig. 1b). These cells stained strongly with polyclonal anti‐S100 and antimelanoma HMB‐45 antibodies (Dako, Glostrup, Denmark). A diagnosis of endolymphatic spread of melanoma was made. The patient refused any chemotherapy and was alive with the disease at the last follow‐up examination performed 4 months after the diagnosis of metastatic skin disease.
