Short communication
Melanoma metastasis to the breast: A diagnostic pitfall

https://doi.org/10.1016/j.canep.2009.04.001Get rights and content

Abstract

Background: Breast metastasis is an extremely rare phenomenon. While nearly every malignancy has been described to metastasize to the breast; melanoma, lymphoma and leukemia tend to be the most common. Among these primary tumors, melanoma metastasis represents a diagnostic pitfall for both the clinicians and histopathologists. Methods: We report a case of widely metastatic malignant melanoma with diagnostic difficulties in both clinical and histopathological evaluation. Thorax CT, Abdominal MRI, tumor marker screening and two biopsies were performed to conclude the primary. Results: In clinical evaluation, there were rapidly proliferating multiple nodular lesions at the skin, breasts, lungs, ovaries and peritoneum accompanied by only increased CA 125 in tumor marker panel. The initial biopsy performed from a skin nodule was concordant with a metastatic carcinoma suggesting breast as the primary. The diagnosis was made by immunohistochemical staining of the second biopsy performed from a breast nodule. Conclusion: Although no strict clinical criteria exist to differentiate a melanoma metastasis to the breast from a primary breast carcinoma atypically rapid growth, normal Ca 15-3 level, and a history of prior melanoma may be helpful. However, it may be still misdiagnosed in some cases even histopathologically if the immunohistochemical staining is not performed.

Introduction

The breast is a rare site for metastatic tumors [1]. Involvement of the breast by metastatic melanoma is also rarely reported resulting in its very rare clinical consideration. On the other hand, melanoma can be misdiagnosed as adenocarcinoma microscopically because of its protean histologic patterns. These features make melanoma metastasis to the breast a diagnostic pitfall. We report a case of widely metastatic malignant melanoma with diagnostic difficulties in both clinical and histopathological evaluation.

Section snippets

Case report

The patient was a 39-year-old woman with complaints of painful nodules at the trunk, head and neck, and loss of appetite for 1 month. Her past medical history was unremarkable. In the physical examination, there were multiple skin nodules, some of them with purplish discoloration (Fig. 1), ranging between 0.5 and 3 cm at the head, neck, chest wall, back, and abdomen; nodules seated in bilateral breast tissue, and hard, fixed lymphadenopathies of the right supraclavicular region. The nodules were

Discussion

Melanoma metastasis to the breast is a diagnostic challenge. Breast metastasis from any extramammary tumor is extremely rare, including malignant melanoma, making its clinical consideration also very rare [1]. Furthermore, malignant melanoma can produce diagnostic problems also microscopically because of its protean histologic patterns [2]. In some cases, it can hardly be distinguished from an adenocarcinoma on simple microscopic examination of H and E stained samples [2]. This was also the

Conflict of interest statement

There is no conflict of interest.

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