PMC3680231_01
Left thigh medial aspect showed multiple papulonodular lesions that coalesced to form a plaque in dermatomal segment L2-L3.
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figure1
The sole of the left foot showed a larger ulcerated, ill-defined, pigmented lesion of size 4 cm x 5 cm, present laterally, and a smaller pigmented firm plaque of size 2 cm x 3 cm with well-defined margins and a raised surface, present medially.
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figure2
On complete examination of the patient, two non-tender lesions were found on the sole of the left foot (Figure 2).
a. Photomicrograph from the primary origin ulcerated site simulated acantholytic bullous lesion in the scanner view (H & E; 100x). b. Photomicrograph exhibiting neutrophilic and fibrinous exudate toward the ulcerated surface (arrow). Tumour cell nests are present deep in the reticular dermis (H & E; 200x). c. Proliferation of single atypical pigmented melanocytes and nests (black arrow) seen in the epidermal layers. Increase in dermal blood vessels with proliferating new vessels present in the dermis (blue arrow) (H & E; 100x). d. Photomicrograph showing dense infiltration of melanoma cells with pigment at places. Atypical cells have descended deep into the reticular dermis (H & E; 100x).
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figure3
A histopathological examination from the primary site with clinically evident ulcerated surface showed a lesion simulating acantholytic bulla in the scanner view (Figure 3a). The keratin layer thickness of the plantar surface was normal and exhibited evidence of ulceration with neutrophilic and fibrinous exudation toward the surface (Figure 3b). An increase in dermal blood vessels with proliferating new vessels was present in the dermis (Figure 3c). The haematoxylin and eosin-stained section from the non-ulcerated area of the primary site showed architectural changes within the epidermis, with poor circumscription of melanocytes, which were present as intra-epidermal nests and single cells beyond the basal level, often exhibiting cytoplasmic melanin pigment (Figure 3d).
Photomicrograph from the metastatic site showing a circumscribed tumour nodule of hyperchromatic tumour cells in dermis with no junctional activity (green arrow). A small tumour nest (blue arrow) and perineural tumour focus (black arrow) are seen in upper dermis (H & E; 100x).
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figure4
The overlying epidermis was largely unremarkable (Figure 4).