gms | German Medical Science

Introduction: Melanoma is the skin cancer associated with the worst prognosis and it has a variety of distinct presentations. Amongst the melanoma subtypes polypoid melanoma is felt to be the most malignant. We describe the unusual case of a patient who presented with a large exophytic, fungating mass on her shoulder, which started as a pre-existing nevus that changed and grew rapidly over the course of several months. A surgical excision of the mass was performed revealing a large polypoid melanoma with ulceration. She was given the diagnosis of melanoma, ulcerated, with a Breslow’s depth of 3 cm (T4b).

Material and methods: Case Report

Results: The lesion measured approximately 10 cm in diameter and an additional safety margin of 2.5 cm was taken in all directions. The lesion was excised down to the fascia and split thickness skin graft harvested from the right thigh was used.

A diagnosis of melanoma, ulcerated, Clark’s Level IV, Breslow measurement of 3 cm was given.

Conclusion: We present the case of a polypoid melanoma with a Breslow depth of approximately 3 cm and ulceration (T4b). The patient felt that this malignancy arose out of a pre-exisiting nevus and first noted a change two to three months before her presentation to hospital. The melanoma was excised surgically and, though metastases were suspected, the patient remained symptom-free and so chemotherapy had yet to be introduced. This case highlights the potentially aggressive nature of melanoma when medical attention is not quickly sought and is an example of the astonishing depths melanoma can reach.