Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 1
INTRODUCTION
Malignant melanoma is one of the most aggressive neoplasms of the skin. It originates from the melanocytes, which are cells embryologically
derived from the neural crest to end up in the epidermal basal layer forming the melanic-epidermal unit where melanocytes and keratinocytes have a proportionality of 1/36.2. It is characterized by producing pigmentation as well as being susceptible to metastasis.[1,2]
It frequently occurs in four clinical varieties according to Clark et al. and McGovern: (1) Surface extension melanoma, (2) lentigo malignant melanoma, (3) nodular melanoma, and (4) lentiginous acral melanoma. There are some other less common clinical varieties such as mucosal and paramucosal melanoma. It is a multifactorial disease
where the predisposing factor is intense exposure to ultraviolet (UV) rays and Caucasian race.[3,4]
The factors that increase the possibility of suffering a malignant melanoma are family history of melanoma (regardless of type or location), personal history of some type of cancer, large congenital nevi, high number of acquired nevi or atypical pigmented lesions, and genetic predisposition for mutations in CDKN2A and CDK4.[5]
In the world the incidence of skin cancer has been increasing, every year 2–3 million cases of non-melanoma skin cancer and 132,000 cases of melanoma. One in three patients diagnosed with cancer has skin cancer.[3,4]
Cutaneous melanoma represents 4% of malignant tumors of the skin, and its survival depends on the extent of the
CASE REPORT
Nodular Malignant MelanomaJiménez-Báez María Valeria1, Cachón-Santana Cindy Margarita2, Rodríguez-Cruz Andrea Elizabeth2, Milla-González Ludivina3, Luis Sandoval Jurado1, Maria Margarita Chavez Hernandez1, Enrique Leobardo Ureña Bogarín1
1Department of Medical Services, Mexican Social Security Institute, Delegation in Quintana Roo, Clinical Research Group of IMSS in Quintana Roo (GRICIQ), Mexico, 2Health Sciences Division, University of Quintana Roo, Mexico General Hospital Clinical Cycles No. 17, Mexican Institute of Social Security, Cancun, Quintana Roo, México, 3Department of Internal Medicine, Mexican Social Security Institute (IMSS), Medical Dermatologist of IMSS Cancún, Mexico
ABSTRACT
Malignant melanoma is one of the most aggressive neoplasms of the skin. It originates from the melanocytes, which are cells derived embryologically from the neural crest and migrate to the epidermal basal layer. It is characterized by producing pigmentation as well as being susceptible to metastasis. We report the case of a 36-year-old female patient with advanced clinical stage and distant commitment. The biopsy confirmed the presence of Grade III invasive nodular cutaneous melanoma in the left subscapular region with lymph node metastasis with reactive hyperplasia. An exploratory research is carried out with the bibliographic review in scientific journals with evidence level II–IV. In portals PubMed, Redalyc, BVS, and UpToDate. 81241 met criteria 2248 of which 629 were chosen for having access to the full text and of these 496 are more current (as of 2008), and in the end, 27 articles were selected that met all the inclusion criteria to this article. Due to the increase in the incidence of this disease in recent years and its poor prognosis in short to medium term, it is important to know and follow-up on patients with known risk factors for this disease such as the presence of previous nevi, with emphasis on measures of prevention.
Key words: Metastasis, nodular malignant melanoma, skin
Address for correspondence: Jiménez-Báez María Valeria, Jefatura de Servicios Prestaciones Médicos Av. Politécnico Nacional S/N SMZ 509, CP. 77533 Cancún, Quintana Roo, Mexico. E-mail: [email protected]
© 2019 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
Valeria, et al.: Nodular Malignant Melanoma
2 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
disease.[6,7] The most common clinical variant of malignant melanoma in the world is a superficial extension (60–70% of cases) followed by nodular melanoma (15–30%) and acral lentiginous melanoma (5–10%).[5,6]
In Latin America, the International Agency for Research on Cancer estimates a frequency of presentation of 2 per 100,000 inhabitants. In Mexico, melanoma ranks tenth in all neoplasms and third in skin cancer with 14.1%.[8]
It is one of the most common neoplasms in the young adult, with predominance in the female sex during the three decades of life.[6]
The presentation in men is in the trunk and women, it is in the lower extremities.[3]
Its incidence has increased in recent years around the world, having a higher peak in tropical countries because they are exposed to the sun since childhood, the lack of habit by not using sunscreen, and the greater diagnosis by the dermatoscope that allows detecting early lesions.[9]
Melanoma ranks third with 7.9% in Mexico and is the cause of 75% of deaths from skin cancer.[10] In Mexico, the true incidence of malignant melanoma is unknown;[11] however, in 2012 the Dermatological Center of Yucatan found 177 patients with skin cancer, where melanoma had a prevalence of 1.7% [12] The purpose of this work is to report a case of malignant nodular malignant melanoma, with an apparent spontaneous regression, whose personal ignorance of the patient for attention to the presence of spots or moles and the doctor of opportunity for the appropriate derivation, led to an injury invasive.
CASE REPORT
This is a 33-year-old female patient, originally from Holpelchen, Campeche and residing in Cancún, Quintana Roo, referred to primary health-care medical unit with a diagnosis of Nevo Melanocitico, who goes to the dermatology service for presenting dermatosis located in the left infrascapular region, constituted by neoformation formed by two exophytic lesions with 4 cm, hyperchromic macula with an exophytic center and heterochromia of three variations color, hypochromic with pink tint, dark brown and bluish black, with perilesional achromic halo and palpation with induration, mobile and painful and not adhered to deep planes [Figure 1]. He began his condition 5 years ago with a small nevus, which has been adding occasional bleeding and pain for 3 years, with progressive growth to the present date. He mentions faster growth after his last pregnancy.
An excisional biopsy of the lesion was performed in the dermatology department where an asymmetric proliferation of atypical epithelioid and spindle-shaped melanocytes was observed, individually and confluently arranged in
discohesive nests and mantles that invade the nerve fibers, and the muscle tissue present in the cut. The melanocytes are large, pleomorphic with pale cytoplasm, eosinophilic with melanic pigment in their interior. The nuclei are of irregular, hyperchromatic, and pleomorphic contours, some of them show individual cell necrosis.
Given the histopathology result, a secondary intervention was performed 14 days after the first one for the widening of margins and left axillary dissection. The histopathological report of the piece showed 3 mitoses/mm2. In the papillary dermis and superficial reticular lymphocyte inflammatory infiltrate that surrounds and infiltrates the neoformation, there is a fall of pigment with melanophages and cytoid bodies. Residual axillary conglomerate with melanoma metastasis, nine ganglia with reactive hyperplasia.
The final histopathological report details a Grade III invasive nodular cutaneous melanoma of at least 12 mm thickness on the Breslow, Clark level V scale of the skin of the left subscapular region.
It is sent to the oncology service 2 days after the second intervention where a computerized axial tomography (CT) is indicated that reported asymmetric breasts in size, cystic lesion of the right ovary 21 mm × 17 mm suggestive of metastasis. As prophylaxis against a possible invasion of the central nervous system, it was indicated to initiate radiotherapy and pegylated interferon and ipilimumab as adjuvant therapy.
DISCUSSION
Nodular malignant melanoma is a tumor that affects people of any age, especially young adults.[13] The main risk factor is exposure
Figure 1: Neoformation consisting of two exophytic lesions on a hyperchromic macula with an exophytic center and heterochromia of the color of three variations, hypochromic with pink tint, dark brown, and bluish black, with acromic halo perilesion
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 3
to sunlight, which produces variations in DNA and its suppression of cellular apoptosis bound to skin phototype I and II.[14] It appears mainly in the trunk and extremities, presenting initially and exclusively vertical growth phase, conditioning aggressive behavior, and worse prognosis.[14] This type of melanoma has an orientation to lymphatic and hematic dissemination, and up to 4% of cases it is discovered by metastasis.[15]
In this case, the location of the tumor was found in a protected photo area in the subscapular region, characteristic of this variant of melanoma and skin phototype III, as well as metastases to lymph nodes.
In most patients, the disease is detected when localized and can be cured by excreting the primary tumor in situ; however, many patients are diagnosed in the metastatic phase. The 10-year survival rate with metastasis is <10%.[8] The delay in the diagnosis of malignant melanoma is common in the
pediatric population and can be attributed to the atypical presentation, although on other occasions it is due to the reluctance to consider the condition.[9] It is fundamental, therefore, to apply the ABCDE criteria with the help of dermatoscopy and biopsy in highly suggestive cases.[9,10]
As for the clinic, it depends fundamentally on its growth pattern; the majority is initially presented with a phase of radial growth (intraepidermal) and later a vertical growth consisting of a growth toward the dermis leading to the vicinity of vascular and lymphatic structures causing or increasing the chances of metastasis, a situation that occurred in our case where the radial phase was minimal, and the vertical phase was the one that prevailed leading to a darker prognosis. In a study conducted by Calderón et al. in 2017, they found nRAS mutations in 28%, as well as their mean evolution time was 7.79 years.[16-18] In the case of our patient, she had a diagnostic delay of 4.5 years.
Chart 1: Studies related to the results of nodular malignant melanoma
Valeria, et al.: Nodular Malignant Melanoma
4 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
(Con
td...
)
Tabl
e 1:
Sum
mar
y Ta
ble
of in
clud
ed s
tudi
esN
o.R
efer
ence
Met
hods
Res
ults
Con
clus
ions
1M
elan
oma
cutá
neo[1
]R
evie
wR
evie
wC
utan
eous
mel
anom
a is
the
mos
t m
alig
nant
tum
or o
f the
ski
n an
d ha
s a
grea
t cap
acity
to m
etas
tasi
ze.
Eve
n w
hen
som
e ris
k fa
ctor
s ar
e kn
own,
dia
gnos
is a
nd e
arly
tr
eatm
ent a
re th
e on
ly s
trat
egie
s th
at h
ave
been
sho
wn
to im
prov
e th
e pr
ogno
sis
of th
ose
who
suf
fer
from
it, a
nd it
s m
anag
emen
t is
a ch
alle
nge
2E
stud
io e
pide
mio
lógi
co d
e m
elan
oma
mal
igno
en
el A
mer
ican
Brit
ish
Cow
dray
M
edic
al C
ente
r[2]
Ret
rosp
ectiv
e, d
escr
iptiv
e,
and
linea
r st
udy
123
hist
opat
holo
gica
l rep
orts
wer
e in
clud
ed, c
orre
spon
ding
to 6
3 m
ale
patie
nts
and
60 fe
mal
e pa
tient
s. T
he
age
rang
ed b
etw
een
19 a
nd 9
7 ye
ars.
73
cas
es w
ere
prim
ary,
of t
hem
61,
of
skin
and
12,
ext
racu
tane
ous,
50
wer
e m
etas
tase
s: 3
0 in
lym
ph n
odes
and
20
extr
anod
al. T
he p
redo
min
ant C
lark
leve
l w
as II
I, an
d B
resl
ow II
. 57
case
s w
ere
HM
B45
and
50
posi
tive
to S
100
The
freq
uenc
y of
this
neo
plas
m
attr
acts
atte
ntio
n in
com
paris
on w
ith
othe
r gr
oups
, as
wel
l as
the
num
ber
of e
xtra
cuta
neou
s m
alig
nant
m
elan
omas
and
the
num
ber
of e
xtra
noda
l met
asta
ses.
We
cons
ider
an
impo
rtan
t con
trib
utio
n to
an
epid
emio
logi
cal s
tudy
that
sh
ould
be
carr
ied
out a
t the
nat
iona
l le
vel
3E
pide
mio
logí
a de
l cán
cer
de p
iel e
n pa
cien
tes
de la
Clín
ica
de D
erm
ato-
onco
logí
a de
l Cen
tro
Der
mat
ológ
ico
Dr.
Lad
isla
o de
la P
ascu
a. E
stud
io
retr
ospe
ctiv
o de
los
últim
os o
cho
años
[3]
Des
crip
tive
and
retr
ospe
ctiv
e st
udy
case
s an
d co
ntro
lsW
e re
view
ed 2
185
reco
rds
with
474
3 hi
stop
atho
logi
cally
con
firm
ed le
sion
s.
The
mos
t com
mon
cut
aneo
us n
eopl
asm
w
as b
asal
cel
l car
cino
ma,
with
a
prev
alen
ce o
f 74%
(w
ith p
redo
min
ance
of
the
clin
ical
tum
or a
nd s
uper
ficia
l va
riety
, res
pect
ivel
y), f
ollo
wed
by
epid
erm
oid
carc
inom
a w
ith 1
4% (
nodu
lar
kera
totic
type
and
Bow
en’s
dis
ease
) an
d m
alig
nant
mel
anom
a w
ith 3
% (
nodu
lar
varie
ty a
nd le
ntig
inou
s ac
ral).
We
also
fo
und:
Sar
com
as, c
utan
eous
lym
phom
as
and
derm
atof
ibro
ma
spro
tube
rans
. B
asal
cel
l and
epi
derm
oid
carc
inom
as
pred
omin
ated
in th
e se
vent
h de
cade
of
life
(26
and
24%
, res
pect
ivel
y), m
alig
nant
m
elan
oma
was
obs
erve
d in
the
sixt
h de
cade
(20
%)
and
the
rest
of t
he
neop
lasm
s in
the
fifth
dec
ade.
The
mos
t co
mm
on v
arie
ties
in th
e hi
stop
atho
logi
cal
findi
ngs
wer
e: S
olid
bas
al c
ell c
arci
nom
a,
The
res
ults
of t
his
stud
y co
inci
de w
ith th
at r
epor
ted
in
the
inte
rnat
iona
l bib
liogr
aphy
, ex
cept
for
the
high
er fr
eque
ncy
of
neop
lasm
s in
wom
en. W
e ag
ree
with
the
info
rmat
ion
that
is r
epor
ted
in o
ur c
ount
ry
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 5
Tabl
e 1:
(Con
tinue
d)
(Con
td...
)
wel
l-diff
eren
tiate
d sq
uam
ous
cell
carc
inom
a, m
alig
nant
lent
igo
mel
anom
a,
Kap
osi’s
sar
com
a an
d cu
tane
ous
B-c
ell l
ymph
oma.
Neo
plas
ms,
incl
udin
g m
ucou
s m
embr
anes
, wer
e fo
und
in a
ll bo
dy s
egm
ents
. Mos
t of t
he le
sion
s w
ere
foun
d in
the
phot
o-ex
pose
d ar
eas
4P
reva
lenc
ia d
el c
ánce
r de
piel
en
tres
ciud
ades
de
Méx
ico[5
]R
etro
spec
tive,
des
crip
tive
and
linea
r st
udy
Fre
quen
cy w
as s
tudi
ed b
y ge
nder
, age
, top
ogra
phy,
af
fect
ed o
rgan
, Cla
rk a
nd
Bre
slow
leve
ls, s
tudi
es w
ith
imm
unoh
isto
chem
istr
y an
d m
etas
tase
s
We
exam
ined
443
sub
ject
s in
whi
ch
eigh
t cas
es o
f ski
n ca
ncer
wer
e do
cum
ente
d, s
even
in w
omen
and
one
in
men
, of w
hich
six
cor
resp
ond
to b
asal
ce
ll ca
rcin
oma
and
two
to m
alig
nant
m
elan
oma,
thre
e of
thes
e in
pat
ient
s w
ith
phot
otyp
e II,
two
with
pho
toty
pe II
I and
th
ree
with
pho
toty
pe IV
. 75%
of p
atie
nts
diag
nose
d w
ith s
kin
canc
er h
ad n
o hi
stor
y of
pre
mal
igna
nt le
sion
s, h
owev
er,
anal
yzin
g th
e su
spic
ious
lesi
ons
foun
d a
sign
ifica
nt r
elat
ions
hip
betw
een
the
pres
ence
of c
ance
r an
d th
ese
lesi
ons,
w
ith a
n in
crea
sed
risk
of 3
.4 ti
mes
The
sam
ple
size
was
sm
all,
with
he
tero
gene
ous
popu
latio
n gr
oups
, so
the
resu
lts a
re n
ot c
ompa
rabl
e to
wha
t hap
pens
in o
ther
sta
tes
of
the
coun
try
5E
pide
mio
logí
a de
l cán
cer
de p
iel e
n el
Cen
tro
Der
mat
ológ
ico
de Y
ucat
án
dura
nte
2012
[6]
Ret
rosp
ectiv
e, d
escr
iptiv
e an
d ob
serv
atio
nal s
tudy
.A
ll pa
tient
s di
agno
sed
with
sk
in c
ance
r co
nfirm
ed w
ith
the
hist
opat
holo
gica
l stu
dy.
The
ana
lysi
s of
the
data
was
ca
rrie
d ou
t with
des
crip
tive
stat
istic
s, c
alcu
latio
n of
pr
opor
tions
and
mea
sure
s of
ce
ntra
l ten
denc
y
We
foun
d 17
7 pa
tient
s w
ith s
kin
canc
er.
The
pre
vale
nce
was
1.7
%, 3
9% m
en
and
61%
wom
en. T
he a
vera
ge a
ge w
as
63.7
yea
rs. 5
3.6%
wer
e en
gage
d in
ho
usew
ork.
93.
8% c
ame
from
Yuc
atan
. T
he m
ost f
requ
ent t
umor
was
bas
al c
ell
(77%
), fo
llow
ed b
y sp
inoc
ellu
lar
(21%
) an
d m
elan
oma
(2%
). T
he m
ost a
ffect
ed
regi
on w
as th
e fa
ce (
74.2
%).
The
re w
ere
28 p
atie
nts
with
mul
tiple
ski
n ca
ncer
. The
av
erag
e tim
e of
evo
lutio
n w
as 3
1 m
onth
s
Ski
n ca
ncer
was
one
of t
he m
ain
reas
ons
for
cons
ulta
tion
at th
e C
entr
o D
erm
atol
ógic
o de
Yuc
atán
in
201
2. It
was
mor
e fr
eque
nt in
Y
ucat
ecan
wom
en in
the
seve
nth
deca
de o
f life
. Ped
iatr
ic c
ases
and
m
ultip
le s
kin
canc
er w
ere
desc
ribed
*Mor
e st
udie
s ar
e re
quire
d to
kno
w
the
real
effe
ct o
f the
dis
ease
6M
elan
oma
cutá
neo:
12
años
de
expe
rienc
ia[7
]R
etro
spec
tive,
obs
erva
tiona
l, de
scrip
tive
and
tran
sver
sal
stud
y. W
e re
view
ed th
e fil
es o
f pat
ient
s of
the
Der
mat
olog
y an
d D
erm
ato-
onco
logy
Dep
artm
ent o
f the
G
ener
al H
ospi
tal o
f Mex
ico
with
a r
egis
tere
d di
agno
sis
of
hist
opat
holo
gica
lly p
rove
n
We
incl
uded
195
cas
es o
f cut
aneo
us
mel
anom
a co
nfirm
ed w
ith th
e hi
stop
atho
logi
cal r
epor
t, of
thes
e 19
ca
ses
with
inco
mpl
ete
file
wer
e ex
clud
ed.
176
case
s w
ere
obta
ined
, of w
hich
57
(32%
) w
ere
men
. Len
tigin
ou s
acra
l m
elan
oma
affe
cted
105
cas
es (
60%
),
follo
wed
by
nodu
lar
mel
anom
a w
ith 3
6 ca
ses
(20%
), le
ntig
o m
alig
nant
The
freq
uenc
y of
mel
anom
a sh
owed
var
iabl
e in
crea
se in
eac
h re
gist
ered
yea
r. A
hig
her
prop
ortio
n of
affe
cted
wom
en w
as fo
und,
the
aver
age
age
of th
e po
pula
tion
was
62
.62
year
s. T
he m
ost f
requ
ent
subt
ype
was
lent
igin
ous
acra
l m
elan
oma,
follo
wed
by
nodu
lar
mel
anom
a. S
ubun
gual
mel
anom
a
Valeria, et al.: Nodular Malignant Melanoma
6 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
Tabl
e 1:
(Con
tinue
d)
(Con
td...
)
cuta
neou
s m
elan
oma,
at
tend
ed fr
om J
anua
ry 1
, 20
03, t
o D
ecem
ber
31, 2
014.
T
he s
tatis
tical
ana
lysi
s w
as
carr
ied
out d
escr
iptiv
ely
thro
ugh
the
prog
ram
SP
SS
v
20.0
mel
anom
a in
23
case
s (1
3%)
and
supe
rfic
ial e
xten
sion
mel
anom
a in
12
case
s (7
%).
Sub
grou
p an
alys
is w
as
perf
orm
ed fo
r ea
ch s
ubty
pe o
f mel
anom
a
affe
cted
28.
5% o
f pat
ient
s. M
ost
of th
e ca
ses
wer
e de
tect
ed in
ad
vanc
ed s
tage
s
7F
rom
mel
anoc
ytes
to m
elan
omas
[8]
Rev
iew
Rev
iew
Hav
e a
visi
on o
f gen
etic
s of
m
elan
omas
from
thei
r ce
lls o
f orig
in
thro
ugh
diffe
rent
type
s of
pre
curs
or
lesi
ons
will
allo
w u
s to
ach
ieve
an
impr
oved
dia
gnos
is, e
arly
re
cogn
ition
of l
esio
ns th
at h
ave
a hi
gher
ris
k of
pro
gres
sion
and
to
be a
ble
to in
terv
ene
in e
arly
sta
ges
of c
ance
r. T
he g
old
stan
dard
to
eval
uate
the
mal
igna
nt p
oten
tial
of m
elan
ocyt
ic n
eopl
asm
s is
the
hist
opat
holo
gy (
biop
sy).
Bio
mar
kers
ar
e ex
pect
ed to
hel
p us
def
ine
the
prog
ress
ion
of th
e le
sion
s in
divi
dual
ly a
nd a
re e
xpec
ted
to
play
an
incr
easi
ngly
impo
rtan
t ro
le in
hel
ping
the
diag
nost
ic
clas
sific
atio
n.T
he in
fluen
ce o
f UV
rad
iatio
n on
th
e de
velo
pmen
t and
evo
lutio
n of
m
elan
omas
in C
auca
sian
s re
quire
s th
at p
ublic
hea
lth c
ampa
igns
be
diss
emin
ated
to a
void
exc
essi
ve
expo
sure
to th
e su
n
8M
elan
oma.
Fun
dam
ento
s de
l di
agnó
stic
o y
la te
rapé
utic
a[9]
Rev
iew
Rev
iew
Its e
tiolo
gy is
mul
tifac
toria
l, an
d it
has
been
rep
orte
d th
at th
e pr
eval
ence
has
incr
ease
d fo
r ap
prox
imat
ely
two
deca
des.
In
Mex
ico
it ra
nks
seve
nth
in
freq
uenc
y am
ong
all n
eopl
asm
s,
80%
of c
ases
are
in lo
cally
ad
vanc
ed s
tage
s
9C
ompo
rtam
ient
o de
l cán
cer
de p
iel e
n G
üine
s y
San
Jos
é de
las
Laja
s[10]
Rev
iew
Rev
iew
The
mai
n ge
nes
reco
gniz
ed in
m
elan
oma
are
CD
KN
2A a
nd C
DK
4,
invo
lved
in th
e co
ntro
l of t
he c
ell
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 7
Tabl
e 1:
(Con
tinue
d)
(Con
td...
)
cycl
e. In
20%
–50%
of f
amili
al c
ases
of
mel
anom
a m
utat
ions
are
foun
d in
CD
KN
2A. T
he p
olym
orph
ism
s in
the
MC
1R r
ecep
tor,
key
in th
e fo
rmat
ion
of m
elan
in in
res
pons
e to
U
V r
adia
tion,
are
als
o as
soci
ated
w
ith a
n in
crea
sed
risk
of m
elan
oma
10V
alor
ació
n in
icia
l, di
agnó
stic
o,
esta
dific
ació
n, tr
atam
ient
o y
segu
imie
nto
de lo
s pa
cien
tes
con
mel
anom
a m
alig
no p
rimar
io d
e pi
el.
Doc
umen
to d
e co
nsen
so d
e la
“X
arxa
de
Cen
tres
de
Mel
anom
a de
Cat
alun
ya
i Bal
ears
”[11]
Con
sens
usdo
cum
ent
Con
sens
us d
ocum
ent.
Con
fron
tatio
n w
ith
rece
nt li
tera
ture
(in
clud
ing
natio
nal a
nd
inte
rnat
iona
l clin
ical
gui
delin
es),
as
wel
l as
dia
gnos
is, m
onito
ring
and
trea
tmen
t pr
otoc
ols
agre
ed o
n in
the
diffe
rent
ho
spita
l cen
ters
thro
ugho
ut C
atal
onia
an
d th
e B
alea
ric Is
land
s be
long
ing
to
the
Xar
xa d
e C
ente
rs d
e M
elan
oma
de
Cat
alun
ya i
Bal
ears
The
kno
wle
dge
and
diag
nosi
s of
mel
anom
a ar
e of
utm
ost
impo
rtan
ce s
ince
it is
wro
ngly
un
dere
stim
ated
with
res
pect
to
othe
r ty
pes
of c
ance
r.
11M
elan
oma:
Pat
ogén
esis
, clín
ica
e hi
stop
atol
ogía
[12]
Rev
iew
art
icle
Rev
iew
art
icle
The
mai
n ge
nes
reco
gniz
ed in
m
elan
oma
are
CD
KN
2A a
nd C
DK
4,
invo
lved
in th
e co
ntro
l of t
he c
ell
cycl
e. In
20%
–50%
of f
amili
al c
ases
of
mel
anom
a m
utat
ions
are
foun
d in
CD
KN
2A. T
he p
olym
orph
ism
s in
the
MC
1R r
ecep
tor,
key
in th
e fo
rmat
ion
of m
elan
in in
res
pons
e to
U
V r
adia
tion,
are
als
o as
soci
ated
w
ith a
n in
crea
sed
risk
of m
elan
oma
12M
elan
oma
mal
igno
cut
áneo
en
paci
ente
s de
la p
rovi
ncia
de
Las
Tun
as[1
3]
Des
crip
tive
stud
y of
tr
ansv
erse
cut
31 p
atie
nts
atte
nded
at t
he p
lace
and
tim
e pe
riod
refe
rred
to a
bove
Cut
aneo
us m
elan
oma
pred
omin
ated
in th
e m
ale
sex,
in
the
low
er e
xtre
miti
es a
nd a
late
di
agno
sis
was
man
ifest
ed in
the
patie
nts,
with
the
prev
alen
ce o
f C
lark
inva
sion
leve
l IV
and
the
nodu
lar
mel
anom
a as
the
mos
t fr
eque
nt h
isto
logi
cal t
ype
(AU
)
13H
alo
Nev
o y
Vití
ligo:
A p
ropó
sito
de
un
caso
Clin
ic C
ase
We
pres
ent t
he c
ase
of a
boy
with
ac
quire
d ne
vi le
sion
s in
the
back
who
de
velo
ped
strik
ing
achr
omic
are
oles
and
la
ter
achr
omic
spo
ts o
n th
e kn
ee
Mal
igna
nt M
elan
oma
is th
e m
ost
impo
rtant
diff
eren
tial d
iagn
osis
. For
th
is, t
he c
hara
cter
istic
of t
he h
alo
is
orie
nted
: Sym
met
ric a
nd re
gula
r in
the
nevu
s, ir
regu
lar a
nd a
sym
met
ric
in th
e m
elan
oma.
The
cha
ract
eris
tics
of th
e pi
gmen
ted
lesi
on a
lso
mat
ter,
whi
ch m
ust b
e ev
alua
ted
acco
rdin
g to
the
AB
CD
rule
Valeria, et al.: Nodular Malignant Melanoma
8 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
Tabl
e 1:
(Con
tinue
d)
(Con
td...
)
14C
órdo
va B
, Alb
erto
C. M
elan
oma
nodu
lar
en b
orde
de
pie.
Rev
Cie
nc
Méd
201
4;18
:329
-36.
Ava
ilabl
e fr
om: h
ttp://
ww
w.s
ciel
o.sl
d.cu
/sci
elo.
php?
scrip
t=sc
i_ar
ttext
&pi
d=S
1561
-31
9420
1400
0200
016&
lng=
es. [
Last
ac
cess
ed o
n 20
17 O
ct 1
3]
Pre
sent
atio
n of
a c
ase
Eld
erly
pat
ient
with
an
asym
ptom
atic
le
sion
on
the
right
foot
, 4 y
ears
old
, w
ith r
apid
gro
wth
in th
e pa
st 3
mon
ths.
A
clin
ical
-his
topa
thol
ogic
al d
iagn
osis
w
as m
ade,
com
patib
le w
ith n
odul
ar
mel
anom
a. T
he tr
eatm
ent o
f cho
ice
is
surg
ical
rem
oval
Nod
ular
mel
anom
a is
a v
ery
aggr
essi
ve tu
mor
and
sur
viva
l de
pend
s on
an
early
dia
gnos
is,
enab
ling
the
heal
ing
>90%
of c
ases
15S
anto
s V
M, L
eal C
T, V
asco
ncel
los
MJ.
La
te d
iagn
osis
of n
odul
ar m
elan
oma
of
the
foot
in a
74-
year
-old
Bra
zilia
n m
an.
Rev
Med
Chi
l 201
1;13
9:14
81-3
.
Pre
sent
atio
n of
a c
ase
We
desc
ribe
the
late
dia
gnos
is o
f nod
ular
m
elan
oma
of th
e fo
ot in
a 7
4-ye
ar-o
ld
Afr
o-B
razi
lian
mal
e
Sur
gery
is th
e m
ost e
ffect
ive
trea
tmen
t for
MM
in th
e ea
rly
stag
es, a
nd ly
mph
aden
ecto
my
may
be
nece
ssar
y. T
reat
men
t of
late
-sta
ge m
elan
oma
incl
udes
ch
emot
hera
py, c
ryot
hera
py, d
rug
com
bina
tions
, rad
iatio
n th
erap
y,
tum
or in
ject
ions
, tum
or-in
hibi
ting
chem
ical
age
nts,
and
vac
cine
s.Th
e ro
le o
f ear
ly d
iagn
osis
sho
uld
be e
mph
asiz
ed b
ecau
se M
M is
su
scep
tible
to c
ure
if it
is tr
eate
d at
an
early
sta
ge. S
kin
lesi
ons
that
su
gges
t MM
sho
uld
be e
valu
ated
by
a de
rmat
olog
ist b
efor
e th
e bi
opsy
si
nce
timel
y di
agno
sis
and
prop
er
treat
men
t pre
vent
tum
or s
prea
d
16C
eped
a-V
aldé
s R
, Ski
nner
-Tay
lor
C,
Flo
res-
Gut
iérr
ez J
, Ala
nís
S. M
etás
tasi
s en
trán
sito
de
mel
anom
a m
alig
no
cutá
neo:
Rep
orte
de
caso
y r
evis
ión
de la
bib
liogr
afía
. Der
mat
olog
ía C
MQ
20
10;8
:62-
3. A
vaila
ble
from
: http
://w
ww
.med
igra
phic
.com
s/co
smet
ica/
dcm
-201
0/dc
m10
1l.p
df. [
Last
acc
esse
d on
201
7 N
ov 0
8].
Pre
sent
atio
n of
a c
ase
A 6
4-ye
ar-o
ld H
ispa
nic
fem
ale
who
pr
esen
ted
met
asta
sis
afte
r th
e su
rgic
al
rem
oval
of m
alig
nant
mel
anom
a
The
evo
lutio
n of
a p
atie
nt
unde
rgoi
ng th
e re
mov
al o
f m
alig
nant
mel
anom
a sh
ould
be
care
fully
rev
iew
ed b
y th
eir
trea
ting
phys
icia
ns to
dia
gnos
e ea
rly th
e pr
obab
ility
of d
ista
nt m
etas
tasi
s
17M
ar V
, Rob
erts
H, W
olfe
R, E
nglis
h D
R, K
elly
JW
. Nod
ular
mel
anom
a: A
di
stin
ct c
linic
al e
ntity
and
the
larg
est
cont
ribut
or to
mel
anom
a de
aths
in
Vic
toria
, Aus
tral
ia. J
Am
Aca
d D
erm
atol
20
13;6
8:56
8-75
.
Ana
lysi
s of
4 C
ohor
ts: 1
989,
19
94, 1
999,
and
200
4.F
our
coho
rts
wer
e es
tabl
ishe
d to
per
form
th
e an
alys
is, t
he o
rigin
al
path
olog
ical
rep
orts
wer
e re
view
ed, a
nd th
e m
elan
oma
The
inci
denc
e of
thic
k tu
mor
s (4
mm
) in
crea
sed
by 3
.8%
(95
% c
onfid
ence
in
terv
al: 1
.4–6
.2)
and
2.5%
(95
%
conf
iden
ce in
terv
al o
f 0.5
–5.5
) pe
r ye
ar fo
r m
ale
and
fem
ale
patie
nts,
re
spec
tivel
y. T
he m
edia
n th
ickn
ess
of
the
nodu
lar
mel
anom
a at
dia
gnos
is w
as
2.6
mm
com
pare
d to
0.6
mm
for
The
inci
denc
e of
thic
k m
elan
omas
co
ntin
ues
to in
crea
se. N
odul
ar
mel
anom
a is
clin
ical
ly b
ette
r di
ffere
ntia
ted
and
the
pred
omin
ant
cont
ribut
or to
dea
ths
rela
ted
to
mel
anom
as. T
his
repr
esen
ts a
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 9
Tabl
e 1:
(Con
tinue
d)
(Con
td...
)
inci
denc
e ra
tes
stan
dard
ized
by
age
from
198
9 to
200
4 w
ere
com
pare
d w
ith a
nnua
l pe
rcen
tage
cha
nge
usin
g th
e P
oiss
on r
egre
ssio
n
supe
rfici
al e
xten
sion
mel
anom
a. O
ne-th
ird
of p
atie
nts
who
die
d of
mel
anom
a du
ring
the
follo
w-u
p pe
riod
had
thic
k tu
mor
s (4
m
m),
mos
t of w
hich
wer
e no
dula
r sub
type
(6
1%).
Nod
ular
mel
anom
a ac
coun
ted
for 1
4% o
f inv
asiv
e m
elan
omas
but
w
as re
spon
sibl
e fo
r 43%
of d
eath
s fro
m
mel
anom
a in
a to
tal o
f 57,
461
year
s/pe
rson
of f
ollo
w-u
p. In
com
paris
on
and
supe
rfici
al d
iffus
ion,
mel
anom
a co
ntrib
uted
with
56%
of i
nvas
ive
mel
anom
as b
ut o
nly
with
30%
of d
eath
s
chal
leng
e in
pub
lic h
ealth
to r
educ
e m
orta
lity
from
ski
n ca
ncer
18H
ugda
hl E
, Kal
vene
s M
B, P
unte
rvol
l H
E, L
adst
ein
RG
, Aks
len
LA.
BR
AF
-V60
0E e
xpre
ssio
n in
prim
ary
nodu
lar
mel
anom
a is
ass
ocia
ted
with
agg
ress
ive
tum
our
feat
ures
an
d re
duce
d su
rviv
al. B
r J
Can
cer
2016
;114
:801
-8.
Des
crip
tive,
obs
erva
tiona
l ar
ticle
. In
a se
ries
of 2
48
nodu
lar m
elan
oma
posi
tive
patie
nts,
the
tota
l exp
ress
ion
of B
RA
F an
d th
e pr
esen
ce o
f B
RA
F-V
600E
and
tota
l BR
AF
ex
pres
sion
wer
e ev
alua
ted
usin
g im
mun
ohis
toch
emis
try
usin
g tis
sue
sect
ions
ob
tain
ed b
y bi
opsy
. The
st
atus
of t
he m
utat
ion
was
ev
alua
ted
usin
g re
al-ti
me
PC
R in
cas
es w
ith s
uffic
ient
tu
mor
tiss
ue (n
=191
)
A p
ositi
ve e
xpre
ssio
n of
BR
AF
-V60
0E,
pres
ent i
n 86
(35
%)
of th
e ca
ses,
was
fo
und
in a
ser
ies
of 2
48 p
ositi
ve p
atie
nts
with
nod
ular
mel
anom
a, a
nd it
was
si
gnifi
cant
ly a
ssoc
iate
d w
ith a
n in
crea
se
of th
e tu
mor
al th
ickn
ess,
the
pres
ence
of
tum
or u
lcer
atio
n an
d re
duce
d su
rviv
al.
In a
dditi
on, t
he e
xpre
ssio
n B
RA
F-V
600E
w
as a
n in
depe
nden
t pro
gnos
tic fa
ctor
, w
here
as th
e B
RA
F m
utat
ion
stat
us
was
not
sig
nific
ant.
The
re w
as 8
8%
agre
emen
t bet
wee
n B
RA
F a
nd V
600E
in
the
expr
essi
on a
nd s
tatu
s of
the
mut
atio
n
The
exp
ress
ion
of B
RA
F-V
600E
is
a n
ovel
pro
gnos
tic m
arke
r in
pr
imar
y m
elan
oma
19G
utié
rrez
-Vid
rio R
M, C
orté
s-Lo
zano
M
. Con
front
ando
al m
elan
oma
en
el s
iglo
XX
I. M
ed C
utan
Iber
Lat
Am
20
07;3
5:3-
13. A
vaila
ble
from
: http
://w
ww
.med
igra
phic
.com
s/cu
tane
a/m
c-20
07/m
c071
b.pd
f. [L
ast a
cces
sed
on 2
017
Oct
27]
.
Rev
iew
art
icle
Rev
iew
art
icle
Ear
ly d
iagn
osis
and
tim
ely
trea
tmen
t are
the
only
str
ateg
ies
to
impr
ove
the
prog
nosi
s of
pat
ient
s w
ith m
elan
oma
20C
amac
ho C
P, G
erso
n R
, Gón
gora
M
A, V
illal
obos
A, B
lanc
o Y
C, L
ópez
O
. Act
ualid
ades
par
a el
trat
amie
nto
del m
elan
oma
met
astá
sico
, est
ado
del a
rte.
Med
Ass
oc M
ed H
osp
AB
C
2017
;62:
196-
207.
Ava
ilabl
e fr
om:
http
://w
ww
.med
igra
phic
.com
s/ab
c/bc
-201
7/bc
173g
. [La
st a
cces
sed
on
2017
Oct
20]
.
Rev
iew
art
icle
Rev
iew
art
icle
The
incu
rsio
n of
imm
unot
hera
py is
on
e of
the
mai
n cu
rren
t the
rapi
es
for
this
dis
ease
Valeria, et al.: Nodular Malignant Melanoma
10 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
Tabl
e 1:
(Con
tinue
d)21
Ser
na-M
acía
s J,
Sán
chez
-Cas
as N
, M
orat
ó-Ló
pez
A, R
eyes
-Gar
cía
M,
Isus
i-Alc
azar
J. M
elan
oma
mal
igno
cu
táne
o. E
l rol
del
PE
T-C
T Th
e ro
le o
f P
ET-
CT.
GA
MO
. 201
2;11
(2):1
04-1
2.
[cita
do 2
7 O
ct 2
017]
Dis
poni
ble:
http
://w
ww
.els
evie
r.es/
es-r
evis
ta-g
acet
a-m
exic
ana-
onco
logi
a-30
5-ar
ticul
o-m
elan
oma-
mal
igno
-cut
aneo
-el-
rol-X
1665
9201
1230
6599
.
Rev
iew
art
icle
Rev
iew
art
icle
The
stu
dy o
f PE
T-C
T w
ith F
DG
an
d w
ith d
iagn
ostic
CT
is th
e m
ost a
ccur
ate
tech
niqu
e fo
r th
e ev
alua
tion
of M
MC
in S
tage
s IIB
an
d IIC
, with
pos
itive
sen
tinel
lym
ph
node
test
, and
Sta
ges
III a
nd IV
22G
alle
gos
J, N
iew
eg O
. Mel
anom
a cu
táne
o (M
C):
Dia
gnós
tico
y tra
tam
ient
o ac
tual
es. G
ac M
éd M
éx 2
014;
150
Sup
pl
2:17
5-82
. Ava
ilabl
e fro
m: h
ttp://
ww
w.
med
igra
phic
.com
s/ga
ceta
/gm
-201
4/gm
s142
g.pd
f. [L
ast a
cces
sed
on 2
017
Oct
[28]
.
Rev
iew
art
icle
Rev
iew
art
icle
Cut
aneo
us m
elan
oma
is th
e th
ird
mos
t fre
quen
t neo
plas
m in
the
skin
and
the
one
with
the
high
est
evol
utio
n to
war
d m
orta
lity.
The
di
agno
stic
app
roac
h is
of g
reat
im
port
ance
to a
chie
ve a
dequ
ate
ther
apy
23G
aviri
a JL
, Niñ
o C
J. M
elan
oma:
ac
tual
izac
ión
en s
u en
foqu
e y
trata
mie
nto.
Uni
vers
itas
Méd
icas
20
05;4
6:82
-93.
[cita
do 2
7 O
ct 2
017]
D
ispo
nibl
e en
: http
s://w
ww
.reda
lyc.
org/
artic
ulo.
oa?i
d=23
1018
6630
03
&id
p=1&
cid=
4342
067
Rev
iew
art
icle
Rev
iew
art
icle
Its d
iagn
osis
is m
ade
thro
ugh
a th
orou
gh e
xam
inat
ion,
iden
tifyi
ng
the
susp
icio
us c
hang
es o
f pre
-ex
istin
g in
jurie
s or
new
lesi
ons.
Its
mos
t rel
evan
t pro
gnos
tic fa
ctor
in
dete
rmin
ing
the
dept
h, a
s w
ell a
s th
e pr
esen
ce o
r ab
senc
e of
pos
itive
no
des,
pre
senc
e or
abs
ence
of
ulce
ratio
n an
d th
e pr
esen
ce o
r ab
senc
e of
dis
tant
met
asta
ses
24M
ozūr
aitie
nė J
, Bie
lski
enė
K,
Atk
očiu
s V
, Lab
eiky
tė D
. Mol
ecul
ar
alte
ratio
ns in
sig
nal p
athw
ays
of
mel
anom
a an
d ne
w p
erso
naliz
ed
trea
tmen
t str
ateg
ies:
Tar
getin
g of
N
otch
. Sci
Dire
ct 2
015;
51:1
33-4
5.
Ava
ilabl
e fr
om: h
ttps:
//ww
w.a
c.el
s-cd
n.co
m/S
1010
660X
1500
0439
/1-
s2.0
-S10
1066
0X15
0004
39-m
ain.
pdf?
_tid
=8b9
300b
8-c0
29-1
1e7-
bd45
-00
000a
ab0f
01&
acdn
at=1
5096
6721
2_3
8129
f5b4
4e36
7692
7bc2
30c5
8830
9d1.
[L
ast a
cces
sed
on 2
017
Oct
24]
.
Rev
iew
art
icle
Rev
iew
art
icle
In th
is r
evie
w, w
e su
mm
ariz
e th
e da
ta r
ecen
tly o
btai
ned
abou
t th
e ne
w d
rug
appr
oved
by
the
Uni
ted
Sta
tes
Foo
d an
d D
rug
Adm
inis
trat
ion
for
the
trea
tmen
t of
met
asta
tic m
elan
oma
and
the
trea
tmen
t str
ateg
y m
odel
whe
n ta
rget
ing
the
Not
ch g
ene
(Con
td...
)
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 11
25Y
eh I.
Rec
ent a
dvan
ces
in m
olec
ular
ge
netic
s of
mel
anom
a pr
ogre
ssio
n:
Impl
icat
ions
for d
iagn
osis
and
tre
atm
ent.
Fac
Rev
201
6;15
29:1
-8.
Ava
ilabl
e fro
m: h
ttps:
//ww
w.n
cbi.n
lm.
nih.
gov/
pmc/
artic
les/
PM
C49
2675
5/pd
f/f10
00re
sear
ch-5
-886
9.pd
f. [L
ast
acce
ssed
on
2017
Oct
29]
.
Rev
iew
art
icle
Rev
iew
art
icle
It is
nec
essa
ry to
res
ort t
o ge
netic
find
ings
to c
ompl
emen
t th
e di
agno
sis
and
reso
rt to
mor
e sp
ecifi
c tr
eatm
ents
. Gen
etic
pr
ogre
ssio
n m
odel
s w
ill h
elp
us d
evel
op b
ette
r cl
inic
al a
nd
biol
ogic
al h
ypot
hese
s to
dire
ct
futu
re r
esea
rch
in th
e ar
ea o
f m
elan
omas
26R
igel
D, R
ussa
k J,
Frie
dman
R. T
he
evol
utio
n of
mel
anom
a di
agno
sis:
25
year
s be
yond
the
AB
CD
s. C
a C
ance
r J
Clin
201
0;60
:1-1
6. A
vaila
ble
from
: ht
tp://
ww
w.o
nlin
elib
rary
.wile
y.co
m/
doi/1
0.33
22/c
aac.
2007
4/ep
df. [
Last
ac
cess
ed o
n 20
17 O
ct 2
7].
Rev
iew
art
icle
Rev
iew
art
icle
A “
good
clin
ical
eye
” re
mai
ns
esse
ntia
l to
sele
ct s
uspi
ciou
s le
sion
s an
d ev
alua
te th
em e
arly
. As
curr
ent a
ppro
ache
s ar
e re
fined
and
ne
w te
chni
ques
are
dev
elop
ed, t
he
impr
oved
abi
lity
to d
iagn
ose
this
ca
ncer
will
impr
ove
whi
le a
chie
ving
th
e go
al o
f red
ucin
g m
elan
oma
mor
talit
yP
CR
: Pol
ymer
ase
chai
n re
actio
n, P
ET
-CT
: Pos
itron
em
issi
on to
mog
raph
y-co
mpu
ted
tom
ogra
phy,
FD
G: F
lude
oxyg
luco
se, U
V: U
ltrav
iole
t
Tabl
e 1:
(Con
tinue
d)The first 5 years of follow-up after removing melanoma are the most important since 90% of all metastases occur during this period.[11] Follow-up should be done at 3-month intervals in the first 3 years and subsequently every year.[12] The skin should be examined at depth, including the scalp and genital region, particularly in the regional distribution of primary palpation, and the lymph nodes, with attention to the regional lymph node chain, in addition to offering psychosocial support and W of the private sector in the states of Guadalajara and Monterrey. In the country, there are only two public-level teams of this type that are located in the Autonomous University of Mexico and the ABC Medical Center, so their access is complicated for their authorization together with their high cost.
The standard of treatment for melanoma metastasis is surgical intervention, and its goal is to provide relief of symptoms and increase survival time. Due to the great possibility of metastasis at the level of the central nervous system, prophylactic radiotherapy can be considered, as was done in the patient.[23]
In a meta-analysis of 3262 patients with malignant melanoma, it was found that single drug chemotherapy is well tolerated, but is associated with response rates of only 5–20%.[24] In addition, combination chemotherapy and biochemotherapy may raise response rates, but they do not prolong survival and cause greater toxicity.[25]
Immunotherapeutic approaches, such as high doses of interleukin 2, are associated with durable responses in a small percentage of patients.[26] In the case of the patient, chemotherapy was adjuvant with excisional surgery due to the advanced stage of the disease. The chemotherapeutic treatment used in the patient complies with the internationally recommended scheme consisting of pegylated interferon with ipilimumab.[26]
At present, some of the main pathways of melanoma progression are better understood, and it is likely that molecular techniques (specific genomic incorporation and intratumoral expression) play an essential role in making classification schemes that have more power in predicting response to therapy.[27]
It is vital to inform the general population of the risk of suffering from melanoma, especially from the premise of multiple nevi and prolonged exposure to the sun, so that, in an almost routine and obligatory way, it would be the use of appropriate clothing such as hats wide-brimmed, clothing that covers most of the body, the use of sunscreen filters (especially in childhood and adolescence) and self-assessment with application of the ABCDE method.
Melanomas and skin cancers are generally painless, but in this patient, the degree of depth of invasion, as well as the perineural compromise and ulceration, made it painful.
Valeria, et al.: Nodular Malignant Melanoma
12 Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019
melanoma de Catalunya i Balears”. Actas Dermatosifiliogr. 2010;101:129-42. Available fromttp://www.actasdermo.org/es/valoracion-inicial-diagnostico-estadificacion-tratamiento/articulo/S0001731010000591. [Last accessed on 2017 Oct 24].
12. Acosta AE, Fierro E, Velásquez VE, Rueda X. Melanoma: Patogénesis, clínica e histopatología. Rev Assoc Col Dermatol 2009;17:87-108. Available from: http://www.antoniorondonlugo.com/blog/wp-content/uploads/2009/08/revision-m-elanomas.pdf.
13. Palomo AM, Pérez MD, Pérez OR, Yabor VD, Fontaine AM. Melanoma maligno cutáneo en pacientes de la provincia de Las Tunas. Revista electrónica Dr. Zoilo E. Marinello Vidaurreta 2015;12:40. Available from: http://www.revzoilomarinello.sld.cu/index.php/zmv/article/view/483.
14. Aldama C, Arnaldo B, Victoria R, Graciela G, Liz D, Olga A, et al. Halo Nevo y Vitíligo: A propósito de un caso. Pediatrics 2007;34:31-3. Available fromttp://www.scielo.iics.una.py/scielo.php?script=sci_arttext&pid=S1683-98032007000100005&lng=en. [Last accessed on 2017 Oct 04].
15. Córdova B, Alberto C. Melanoma nodular en borde de pie. Rev Cienc Méd 2014;18:329-36. Available fromttp://www.scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-31942014000200016&lng=es. [Last accessed on 2017 Oct 13].
16. Santos VM, Leal CT, Vasconcellos MJ. Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian man. Rev Med Chil 2011;139:1481-3.
17. Cepeda-Valdés R, Skinner-Taylor C, Flores-Gutiérrez J, Alanís S. Metástasis en tránsito de melanoma maligno cutáneo: Reporte de caso y revisión de la bibliografía. Dermatología CMQ 2010;8:62-3. Available fromttp://www.medigraphic.com/pdfs/cosmetica/dcm-2010/dcm101l.pdf. [Last accessed on 2017 Nov 08].
18. Mar V, Roberts H, Wolfe R, English DR, Kelly JW. Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia. J Am Acad Dermatol 2013;68:568-75.
19. Hugdahl E, Kalvenes MB, Puntervoll HE, Ladstein RG, Akslen LA. BRAF-V600E expression in primary nodular melanoma is associated with aggressive tumour features and reduced survival. Br J Cancer 2016;114:801-8.
20. Gutiérrez-Vidrio RM, Cortés-Lozano M. Confrontando al melanoma en el siglo XXI. Med Cutan Iber Lat Am 2007;35:3-13. Available fromttp://www.medigraphic.com/pdfs/cutanea/mc-2007/mc071b.pdf. [Last accessed on 2017 Oct 27].
21. Camacho CP, Gerson R, Góngora MA, Villalobos A, Blanco YC, López O. Actualidades para el tratamiento del melanoma metastásico, estado del arte. Med Assoc Med Hosp ABC 2017;62:196-207. Available fromttp://www.medigraphic.com/pdfs/abc/bc-2017/bc173g.pdf. [Last accessed on 2017 Oct 20].
22. Serna-Macías J, Sánchez-Casas N, Morató-López A, Reyes-García M, Isusi-Alcazar J. Melanoma maligno cutáneo. El rol del PET-CT. GAMO. 2012;11(2):104-12. Disponible en: http://www.elsevier.es/es-revista-gaceta-mexicana-oncologia-305-articulo-melanoma-maligno-cutaneo-el-rol-X1665920112306599
23. Gallegos J, Nieweg O. Melanoma cutáneo (MC): Diagnóstico y tratamiento actuales. Gac Méd Méx 2014;150 Suppl 2:175-82. Available fromttp://www.medigraphic.com/pdfs/gaceta/
Health personnel and patients should be alert to injuries. In case of suspicion of metastatic melanoma, the diagnostic criteria should be applied and the diagnosis confirmed with biopsy and histopathological study, since early identification is decisive. Follow-up must be done to establish the diagnosis in a timely manner.
REFERENCES1. Fuente-García AD, Ocampo-Candiani J. Melanoma cutáneo.
Gac Med Mex 2010;2:146. Available fromttp://www.medigraphic.com/pdfs/gaceta/gm-2010/gm102i.pdf. [Last accessed on 2017 Sep 24].
2. Frías AG, Ortiz HC, Lara HM. Estudio epidemiológico de melanoma maligno en el American British Cowdray medical center. Ann Med 2011;56:196-204. Available from http://www. medigraphic.com/pdfs/abc/bc-2011/bc114d.pdf.
3. Hernández-Zárate S, Medina-Bojórquez A, López-Tello Santillán A, Alcalá-Pérez D. Epidemiología del cáncer de piel en pacientes de la clínica de dermato-oncología del centro dermatológico Dr. Ladislao de la Pascua. Estudio retrospectivo de los últimos ocho años. Dermatología Rev Mex 2012;56:30-7. Available fromttp://www.medigraphic.com/pdfs/derrevmex/rmd-2012/rmd121e.pdf. [Last accessed on 2017 Sep 24].
4. Arenas R. Atlas Dermatología, Diagnóstico y Tratamiento. 3rd ed. México: McGraw-Hill Interamericana; 2009.
5. Jurado-Santa CF, Medina-Bojórquez A, Gutiérrez-Vidrio RM, Ruiz-Rosillo JM. Prevalencia del cáncer de piel en tres ciudades de México. Rev Med Inst Mex Seguro Soc 2011;49:253-8. Available fromttp://www.medigraphic.com/pdfs/imss/im-2011/im113f.pdf. [Last accessed on 2017 Oct 15].
6. Güémez-Graniel MF, Plascencia-Gómez A, GranieL-Lavadores MJ, Dzul-Rosado K. Epidemiología del cáncer de piel en el Centro Dermatológico de Yucatán durante 2012. Dermatol Rev Mex 2015;59:9-18. Available fromttp://www.medigraphic.com/pdfs/derrevmex/rmd-2015/rmd151c.pdf. [Last accessed on 2017 Oct 22].
7. Calderón L, Peniche-Castellanos A, Fierro-Arias L, Montes de Oca-Sánchez G, Arellano-Mendoza I. Melanoma cutáneo: 12 años de experiencia. Dermatol Rev Mex 2017;61:179-89. Available from: http://www.medigraphic.com/pdfs/derrevmex/rmd-2017/rmd173b.pdf.
8. Hunter A, Boris C. From melanocytes to melanomas. Nature 2016;16:345-58. Available fromttps://www.nature.com/nrc/journal/v16/n6/pdf/nrc.2016.37.pdf. [Last accessed on 2017 Oct 24].
9. Gallegos Hernández JF, Melanoma C. Fundamentos del diagnóstico y la terapéutica. Acta Med Gpo 2012;10:207-13. Available from http://www.medigraphic.com/pdfs/actmed/ am-2012/am124h.pdf.
10. Acosta DA, Bravo A, Ruíz D, Acosta GM. Comportamiento del cáncer de piel en Güines y San José de las Lajas. Rev Habana Cienc Méd 2014;20:44-53. Available fromttp://www.medigraphic.com/pdfs/revciemedhab/cmh-2014/cmh141f.pdf. [Last accessed on 2017 Oct 20].
11. Mangas C, Paradelo C, Puig S, Gallardo F, Marcoval J, Azon A, et al. Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de piel. Documento de consenso de la “xarxa de centres de
Valeria, et al.: Nodular Malignant Melanoma
Asclepius MedicAl cAse RepoRts • Vol 2 • issue 1 • 2019 13
gm-2014/gms142g.pdf. [Last accessed on 2017 Oct 28].24. Gaviria JL, Niño CJ. Melanoma: actualización en su
enfoque y tratamiento. Universitas Médicas 2005;46:82-93. Disponible en: https://www.redalyc.org/articulo.oa?id=231018663003&idp=1&cid=4342067.
25. Mozūraitienė J, Bielskienė K, Atkočius V, Labeikytė D.Molecular alterations in signal pathways of melanoma and new personalized treatment strategies: Targeting of Notch. Sci Direct 2015;51:133-45. Available fromttps://www.ac.els-cdn.com/S1010660X15000439/1-s2.0-S1010660X15000439-main.pdf?_tid=8b9300b8-c029-11e7-bd45-00000aab0f01&acdnat=1509667212_38129f5b44e3676927bc230c588309d1. [Last accessed on 2017 Oct 24].
26. Yeh I. Recent advances in molecular genetics of melanoma
progression: Implications for diagnosis and treatment. Fac Rev 2016;1529:1-8. Available fromttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926755/pdf/f1000research-5-8869.pdf. [Last accessed on 2017 Oct 29].
27. Rigel D, Russak J, Friedman R. The evolution of melanoma diagnosis: 25 years beyond the ABCDs. Ca Cancer J Clin 2010;60:1-16. Available fromttp://www.onlinelibrary.wiley.com/doi/10.3322/caac.20074/epdf. [Last accessed on 2017 Oct 27].
How to cite this article: Valeria JM, Margarita CC, Elizabeth RA, Ludivina M, Jurado LS, Hernandez MMC, Bogarín ELU. Nodular Malignant Melanoma. Asclepius Med Case Rep 2019;2(1):1-13.