| magnetic resonance imaging (MRI) findings in three patients with primary anorectal malignant melanoma are described. Two patients had melanotic and one had amelanotic anorectal melanoma. The findings of MRI with a pelvic coil and an endorectal coil were consistent with pathologic findings. MRI with a pelvic coil demonstrated the melanotic component as high signal intensity on T1-weighted imaging. MRI with a pelvic coil and an endorectal coil was useful for staging anorectal melanoma. This article describes the initial report of the use of an endorectal coil for malignant melanoma of the anorectum. ( info) |
32/65. Primary treatment of choroidal amelanotic melanoma with photodynamic therapy. The management of choroidal melanoma involves a delicate balance between preserving vision and preventing metastasis. Plaque brachytherapy has become standard management of most small lesions; however, this can result in radiation retinopathy and optic neuropathy. Transpupillary thermotherapy avoids these side-effects; however, it can also result in visual loss and its effectiveness is limited in amelanotic lesions. Photodynamic therapy with verteporfin has shown promise in animal studies of choroidal melanoma, and has recently been used in the management of lesions that have failed to respond to conventional therapy. The authors report a case of primary treatment of a small choroidal amelanotic melanoma with photodynamic therapy using verteporfin. ( info) |
33/65. The first description of sentinel node biopsy in a patient with amelanotic melanoma of the glans penis. We present the first description of sentinel node biopsy in a patient with amelanotic melanoma of the glans penis. The patient underwent partial amputation of the penis due to tumor of the glans. Pathologic examination of the postoperative specimen revealed the presence of a very rare malignancy--amelanotic melanoma. Sentinel node biopsy, with the use of the combined radiotracer/blue dye technique, was performed. Preoperative lymphoscintigraphy was performed the day before surgery. During surgery, blue dye mapping and intraoperative detection of gamma radiation were used. Two sentinel nodes were identified in the left inguinal region and one sentinel node in the right inguinal region. All sentinel nodes were an intense violet color; in each case, the level of radiation in the sentinel node was almost 20 times higher than the level of radiation in the node bed. Routine hematoxylin and eosin staining and immunohistochemistry (HMB-45) revealed the presence of micrometastasis in one of the sentinel nodes harvested from the left inguinal region. Consequently, left inguinal, iliac and obturatory lymphadenectomies were performed. The final pathologic examination revealed the presence of one metastasis (diameter, 2 mm) in one of the resected non-sentinel nodes. No relapse has been observed during 18 months of follow-up. ( info) |
34/65. Cavitary choroidal melanoma. CASE REPORT: We report an unusual case of cavitary choroidal melanoma. The results of ultrasonography, magnetic resonance imaging, computed tomography, and immunohistochemical studies are presented for a 38-year-old woman who developed an amelanotic tumor in the posterior choroid. B-scan ultrasonography disclosed intratumoral cavitations. Systemic and extraocular extension studies were negative. Enucleation was performed and histopathologic examination showed a choroidal melanoma of spindle cell type, with intratumoral cavitations lined by flattened tumor cells.COMMENTS: The majority of previous reports of intraocular cavitary tumors describe cavitary ciliary body tumors. Uveal melanoma should be included in the differential diagnosis of choroidal cavitary lesions. As far as we know, this is the second documented clinicopathologic correlation of a cavitary choroidal melanoma. ( info) |
35/65. Choroidal amelanotic melanoma in a patient with oculocutaneous albinism. CASE REPORT: We describe the clinical presentation of a choroidal amelanotic melanoma in a 46-year-old woman with oculocutaneous albinism. Clinical aspects, investigations, and management are presented, and findings from computed tomography and magnetic resonance imaging are described. Microscopic findings and histopathological features, demonstrating a spindle B-cell melanoma of the choroid, are also reviewed. COMMENTS: magnetic resonance imaging may be helpful in diagnosing amelanotic melanoma in patients with oculocutaneous albinism. ( info) |
36/65. dermoscopy for "true" amelanotic melanoma: a clinical dermoscopic-pathologic case study. Completely amelanotic melanomas are rare and therefore often misclassified, with tragic consequences for patients. The use of dermoscopy for these lesions has not been validated yet because of the lack of studies that are based on large series. The analysis of the vascular pattern, which is often the only dermoscopic parameter to be seen, is therefore essential for a correct diagnosis. We present a case of "true" amelanotic melanoma on the forehead of an 89-year-old man, which clinically mimicked squamous cell carcinoma. The patient was investigated both clinically and by focusing on his dermoscopic features and their pathologic correlates. The dermoscopic diagnostic algorithms routinely used for pigmented lesions are not helpful in diagnosing amelanotic melanoma because they are based on specific parameters not normally seen in amelanotic lesions. In the light of our experience, pattern analysis is the most reliable method for diagnosing these particular lesions correctly because it allows in-depth morphologic analysis of the few parameters found. ( info) |
37/65. Subungual amelanotic malignant melanoma. We report a 61-year-old, male patient complaining from prolonged lesion on his great toe that has been previously treated surgically. Histopathological examination of toenail specimen revealed the presence of nests of atypical tumor cells that led to the diagnosis of amelanotic malignant melanoma. Four years ago, he was diagnosed as gout due to extreme erythema and edema in the same toe. He has been taken to surgical treatment and chemotherapy and is still undergoing. As this disease is seen very rarely, it can be misdiagnosed. This situation also has poor prognosis. We presented a case of subungual amelanotic melanoma, as it is rare disease, early and correct diagnosis is very important. ( info) |
38/65. Rapidly progressive bilateral ophthalmoplegia and enlarging sellar mass caused by amelanotic melanoma. A 63-year-old woman with diplopia and bilateral ptosis underwent brain MRI that showed a pituitary mass with signal characteristics suggestive of adenoma. Within one week she had developed nearly complete bilateral ophthalmoplegia. A repeat MRI showed extension of the mass into both cavernous sinuses. hypophysectomy disclosed an amelanotic melanoma. Extensive search for a primary source was unsuccessful. Despite local radiation treatment, the tumor continued to grow and the patient became blind and died within several months of diagnosis. There are seven reported cases of melanoma arising primarily in the sella turcica. Two cases of metastatic melanoma to the cavernous sinuses have been reported. Amelanotic melanoma has not been reported as a cause of cavernous sinus syndrome. ( info) |
39/65. Photodynamic therapy with verteporfin in subfoveal amelanotic choroidal melanoma (A controlled case). A 57-year old man with 2.7 mm thick subfoveal amelanotic choroidal melanoma of the right eye was indicated for photodynamic therapy with verteporfin. The tumor fully disappeared 1 month after the treatment, the visual acuity improved from 4/16 to 4/4. The disease did not recur during 24-month follow-up. ( info) |
40/65. Amelanotic conjunctival melanoma. Conjunctival melanoma is a rare condition of the eye pigment predominantly affecting white adults. We describe a 32-year-old white man with an amelanotic malignant melanoma of the conjunctiva that is not associated with primary acquired melanosis (PAM) or melanocytic nevus. The patient presented with a 2-year history of nonpigmented vascularized nodules of the right eye. Results of hematoxylin and eosin (H and E) staining of the lesion showed an invasive nodule with vertical spreading, invasion of the substantia propria corneae, and ulceration. S100 protein was expressed in the cells of the invasive nodule. HMB45 protein was highly positive in the melanoma cells. The de novo amelanotic malignant melanoma of the conjunctiva we describe is an extremely uncommon tumor mainly affecting white adults. ( info) |