PMC6360959_01
A: Lesion on the sole; C: Linear bleeding seen
on dermoscopy, with large areas of unstructured space; B and
D: PET scan showed elevated glucose metabolism in the macular
papule on the left sole
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f1
A 42-year-old Chinese female, otherwise healthy, presented with a 10-month history of an asymmetric 2 -3 cm erythematous macular papule on her left sole that had increased in size with accompanying minor tenderness (Figure 1). For further verification, a positron emission tomography(PET) scan was performed, showing elevated glucose metabolism in the left groin and in the macular papule (Figure 1). Irregular pigmented spots measuring approximately 0.5cm were visible on the edge of the ring, and the top of the nodule had been pared down, showing small black dots representing dilated capillary loops (Figure 1).
A and B: Histopathology: macular papule showed tumor cells
arranged as nests in dermo-epidermal junction and dermis, and no obvious
melanin was observed; C and D: histopathology: left
inguinal lymph nodes revealed dense infiltration of tumor cells with
rich melanin granules in cytoplasm (hematoxylin & eosin, A, x40; B,
x200 ; C, x40 ; D, x200)
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One month previously, an enlarged lymph node was detected in her left groin which biopsy in the local hospital reported as metastatic melanoma (Figure 2). No microsatellitosis, regression, angiolymphatic invasion, or neurotropism were detected (Figure 2).
A - Tumor cells positive for Melan-A; B - Tumor
cells positive for HMB-45; C - Tumor cells positive for
S-100; D - Tumor cells 40% positive for Ki67; (A, Melan-A
x100; B, HMB-45 x100, ; C, S-100 x100 ; D, Ki67 x40)
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On immunohistochemical analysis, S100, HMB45, and Melan-A were positive and Ki67 was 40% positive (Figure 3).