Gishen K1, Maria DJP2, Khanlari M3, Cho-Vega HJ3, Feun L2, Thaller S1 and Möller MG1*
1Department of Surgery, University of Miami - Miller School of Medicine, USA
2Department of Medicine, University of Miami - Miller School of Medicine, USA
3Department of Pathology, University of Miami - Miller School of Medicine, USA
Background: Cutaneous malignant melanoma is the sixth most commonly diagnosed cancer in the United States with an incidence that is increasing more quickly than any other type of cancer. Fortunately, the majority of the cases are diagnosed at early stage, conferring a better prognosis. However, there are rare giant destructive melanomas >10 cm that are described in the literature, most metastatic at time of presentation. Here we report the clinical case and genomics of the largest giant melanoma without evidence of metastatic disease described to date.Methods: Literature search of Scopus and Pubmed from 1960-2016 was performed using the terms “giant, melanoma, cutaneous melanoma, and non-metastatic.” Cases were reviewed for location, tumor size, Breslow depth, presence of nodal and distant metastases, and surgical and medical treatments. In addition, we report the case of an 84-year-old female who presented with a giant melanoma of the shoulder without evidence of metastatic disease. We describe the clinical characteristics of the tumor and pathologic profile, including immunohistochemistry and genetic analysis.Results: 18 cases of primary giant melanoma were identified in addition to our case. Female: 9. Male: 10. Age 1-88. Most common location was the trunk followed by the extremities. Average largest diameter was 13.3 cm with a range of 5-23 cm. Breslow thickness ranged from 0.45 to 100 mm. Four (21%) of patients were diagnosed with localized disease, four (21%) with loco-regional metastases and eight (42%) with distant metastases. Our patient’s tumor genetic analysis with Amplicon next generation sequencing for melanoma biomarkers was positive for NRAS Q61L but negative for BRAF, CTNNB1, GNA11, GNAQ, and KIT.
Conclusion: Giant malignant melanomas are extremely rare, particularly those without evidence of metastatic disease. While they represent a surgical challenge due to their locally destructive nature, wide local excision and sentinel node biopsy are still considered the standard of care and may be utilized in conjunction with chemotherapy, immunotherapy, or radiotherapy. Additional genetic analysis of particular phenotypes may help us to elucidate differences in behavior patterns of melanomas to better target therapy.
Malignant melanoma; Giant melanoma; Melanoma metastases; Melanoma genetics
Gishen K, Maria DJP, Khanlari M, Cho- Vega HJ, Feun L, Thaller S, et al. Giant Malignant Melanomas and their Clinical Implications: Review of Literature and Case Report. Clin Surg. 2016; 1: 1096.