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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 191-192

Abject health concern in elderly: Cutaneous metastasis of malignant melanoma of anal canal


1 Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
2 University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi University, Delhi 110 095, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Neelam Wadhwa
University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi University, Delhi 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2304_19

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How to cite this article:
Aggarwal D, Wadhwa N. Abject health concern in elderly: Cutaneous metastasis of malignant melanoma of anal canal. Indian J Med Res 2020;152, Suppl S1:191-2

How to cite this URL:
Aggarwal D, Wadhwa N. Abject health concern in elderly: Cutaneous metastasis of malignant melanoma of anal canal. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:191-2. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/191/316817

Patient's consent obtained to publish clinical information and images.


A 76 yr old emaciated male presented to department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, in December 2016, with multiple distinctly bluish to blackish, non-pulsatile, firm-to-hard nodules ranging in size from 0.4 to 1.2 cm over anterior abdominal wall and back and left inguinal lymphadenopathy for past six months [Figure 1]A and [Figure 1]B. Angiosarcoma of the skin and cutaneous metastasis was suspected clinically. Fine-needle aspiration cytology of cutaneous lesions and lymph node demonstrated highly pigmented pleomorphic cells suspicious of malignant melanoma [Figure 2]A and [Figure 2]B. On probing the patient embarrassingly admitted to having large foul-smelling anal ulcerated mass lesion [Figure 1]C for the past three years. Histologic findings of the biopsy of cutaneous lesions and anal mass showed strong immunopositivity for human melanoma black (HMB)-45, confirming diagnosis of malignant melanoma with cutaneous metastasis ([Figure 2]C and [Figure 2]D and inset). The advanced tumour stage precluded surgical intervention, so the family opted for no treatment in view of grim prognosis.
Figure 1: (A) Multiple bluish cutaneous nodules over anterior abdominal wall (red arrows). (B) enlarged left inguinal lymph nodes (blue arrows) and (C) ulcerated anal mass.

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Figure 2: (A and B) FNA smears from cutaneous nodules showing sheets of pleomorphic cells with intracytoplasmic melanin pigment (red arrows) (May Grunwald Giemsa, ×200 and ×400 respectively). (C) Histopathology of skin nodule showing metastatic malignant melanoma with flattening of epidermis (H and E, ×100) and (D) Histopathology of anal lesion (H and E, ×400), (inset) Immunostain for HMB-45 (×400).

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Acknowledgment: Authors acknowledge Dr Sanjay Gupta, department of Surgery, UCMS & GTB Hospital, Delhi, for referring the patient.

Conflicts of Interest: None


    Figures

  [Figure 1], [Figure 2]



 

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