Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 192-194  

Malignant melanoma of male breast with nodal metastasis


Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India

Date of Web Publication4-Feb-2014

Correspondence Address:
Shastry Srikanth
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.126337

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  Abstract 

Malignant melanoma or melanocarcinoma arising from melanocytes is one of the most rapidly spreading malignant tumor of the skin can occur at all ages, but is a rare before puberty. Malignant melanoma is relatively common neoplasm that not long ago was considered almost uniformly deadly. The great preponderance of melanomas arises in the skin; other sites of origin include the oral and anogenital mucosal surfaces, esophagus, meninges and notably the eye. Breast is a very uncommon site for malignant melanoma; here, we present a case of malignant melanoma of male breast with nodal metastasis.

Keywords: Male breast, malignant melanoma, nodal metastasis


How to cite this article:
Srikanth S, Anandam G. Malignant melanoma of male breast with nodal metastasis. Med J DY Patil Univ 2014;7:192-4

How to cite this URL:
Srikanth S, Anandam G. Malignant melanoma of male breast with nodal metastasis. Med J DY Patil Univ [serial online] 2014 [cited 2024 Mar 29];7:192-4. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2014/7/2/192/126337


  Introduction Top


Malignant melanoma arising from melanocytes spreads locally as well as to distant sites by lymphatics and by blood. The etiology is unknown, but there is a role of excessive exposure of skin to sunlight. The breast is associated with a large number of diseases. Cutaneous malignant melanoma and breast can be interrelated in various contexts primary melanoma of breast skin, melanoma metastasis to breast, in-transit metastasis to breast and finally primary breast melanoma. [1] Here, we present a case of malignant melanoma of left breast in a 54-year-male patient, which is a very rare presentation.


  Case Report Top


A 54-year-old male patient presented with a left pigmented ulcerative breast mass lesion of 5 months duration which is rapidly increasing. Clinically, it was diagnosed as pigmented tumor of the breast. Fine needle aspiration cytology (FNAC) was done from the pigmented site and was reported as malignant melanoma. Patient also complained of left axillary lymph node enlargement of size 2 cm × 2 cm, firm to hard with restricted mobility. FNAC smears show highly cellular smears comprising of elongated and spindle shaped tumor cells having prominent nucleoli in a background of melanin pigment [Figure 1]. FNAC from lymph node also show the same picture [Figure 2]. Radical mastectomy along with left axillary clearance was done and we received a breast tissue of size 10 cm × 7 cm × 6 cm [Figure 3]a, externally nipple retracted and just beneath the nipple at areolar region, there is fungating and proliferating brownish black mass seen. The complete breast was removed along with axillary clearance. On cut section, the mass measuring 5 cm × 4 cm × 2 cm, brownish, soft to firm in consistency. Adjacent breast parenchyma is normal with scant adipose tissue [Figure 3]b. Also received an axillary lymph node of size 2 cm × 2 cm. Histologically show groups and nests of atypical nevus cells along with both intra and extracellular melanin infiltrating into the dermis and extending into adjacent breast parenchyma [Figure 4]. Histopathologically was diagnosed as malignant melanoma with nodal metastasis. We could not take the clinical photograph of the patient as patient was not cooperative. Biopsy was taken from the breast lesion and not from the skin. The lesion, which is involved in the breast tissue showed features of malignant melanoma.
Figure 1: Smears showing highly cellular smears arranged in sheets and clusters,which are elongated and spindle shaped with prominent nucleoli in a melanin pigment background ([a] H and E, ×4; [b] H and E, ×40)

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Figure 2: Smears studied from the lymph nodes show highly cellular smears with tumor cells arranged in clusters and in sheets, with pleomorphic and hyperchromatic nuclei with prominent nucleoli in a background of melanin pigment ([a] H and E, ×4; [b] H and E, ×40)

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Figure 3: Grossly showing breast tissue of size 10 cm × 7 cm × 6 cm, externally nipple retracted showing blackish brown tumor tissue beneath the areola (a). Cut section showing brownish black lesion of size 5 cm × 4 cm × 2 cm, soft to firm (b)

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Figure 4: Section showing groups and nests of atypical nevus cells along with both intra and extracellular melanin infiltrating into the dermis and extending into adjacent breast parenchyma ([a] H and E, ×4; [b] H and E, ×40)

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  Discussion Top


Malignant melanoma is a neoplasm of melanocytes of the cells that develop from melanocytes. Once considered uncommon disease the annual incidence is dramatically increasing over last few decades. Early stage melanoma is curable, but if melanoma has metastasized prognosis is grim with a median survival of 6-9 months. Prognosis is also related to type of melanoma. [2]

Melanoma originates from melanocytes, which arise from neural crest and migrate, to uvea, meninges, epidermis and ectodermal mucosa. Melanomas may develop in healthy appearing skin or near a previously existing pre-cursor lesion. A malignant melanoma developing in healthy skin is said to arise de novo. Many of the melanomas are induced by solar irradiation. The greatest risk of sun exposure induced melanoma is associated with acute, intense and intermittent blistering sunburns. The risk is different from squamous and basal cell skin cancers, which are associated with, prolonged long-term sun exposure. Certain lesions are considered precursor lesions of melanoma including dysplastic nevus, common acquired nevus, congenital nevus and cellular blue nevus. Melanomas have two-growth phases radial and vertical. During the radial phase, malignant cells grow in a radial fashion.in the epidermis. With time most melanomas progress to vertical growth phase when the malignant cells invade the dermis and develop the ability to metastasize. Many genes are implicated in the development of melanomas including CDKN2A (p16), CDK4, RB1, CDKN2A (p19), PTEN/MMAC1 and ras. CDKN2A (p16) appears to be especially important in both sporadic and hereditary melanomas.

Malignant melanoma in male breast is an unusual presentation. In the present case, we diagnosed malignant melanoma both cytologically and histologically. Five different histological types of melanomas exist. Superficial spreading melanomas, nodular melanomas, which are especially found on the trunk of males and rapidly advances to vertical growth signifying it a high risk melanoma. Lentigo maligna melanomas, acral lentiginous melanomas and mucosal lentigenous melanomas. [2] Studies have confirmed that extensive radiological studies such as computed tomography, magnetic resonance imaging and positron emission tomography scanning have an extremely low yield in asymptotic patients with primary cutaneous melanoma. [3]

Treatment of choice is surgical resection of the tumor with an oncologically adequate margin. Post-operative radiotherapy and chemotherapy are indicated depending upon the status of metastasis.

Radiotherapy has been tried in mucosal melanoma of the head and neck [4] with disappointing results. Chemotherapy has been used mainly for palliation only. [4]

We present this case because of its rarity and the role of FNAC and histopathology in diagnosing the lesion.

 
  References Top

1.Kurul S, Taº F, Büyükbabani N, Mudun A, Baykal C, Camlica H. Different manifestations of malignant melanoma in the breast: A report of 12 cases and a review of the literature. Jpn J Clin Oncol 2005;35:202-6.  Back to cited text no. 1
    
2.Brick W. Malignant melanoma. Available from: http://www.emedicine.com/med/topic1386. [Last update on 2004 Oct 27].  Back to cited text no. 2
    
3.Swetter SM.. Malignant melanoma. Available from: http://www.emedicine.com/derm/topic257. [Last updated on 2005 Nov 24].  Back to cited text no. 3
    
4.Pandey M, Mathew A, Iype EM, Sebastian P, Abraham EK, Nair KM. Primary malignant mucosal melanoma of the head and neck region: Pooled analysis of 60 published cases from India and review of literature. Eur J Cancer Prev 2002;11:3-10.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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