PMC9773131_01
PMC9773131_02
Heterogeneous brown-to-black patches and plaques with satellite lesions, areas of hypertrichosis and irregular borders, consistent with partially-excised giant congenital melanocytic nevus. (A) Scattered lesions over the lower abdomen. (B) Scattered lesions over the posterior thorax and buttocks. (C) Right mid-back nodular area where the initial incisional biopsy was performed.
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F1
During bedside evaluation, the patient was found to have heterogeneous brown-to-black patches/plaques scattered on his torso, buttocks, and lower abdomen with satellite lesions, areas of hypertrichosis, and irregular borders, consistent with partially-excised giant CMN of bathing trunk distribution (Figure 1).
Histopathologic examination of the sample obtained by incisional biopsy of the right axillary nodule. (A) H&E stain (20 x magnification), showing innumerous irregularly-shaped tumor cells with nuclear hyperchromasia and prominent nucleoli intermixed within fibroadipose tissue. (B) Immunostaining for S100 (10 x magnification) showing diffuse nuclear and cytoplasmic positivity in all tumor cells. (C) Immunostaining for melan-A (10 x magnification) showing diffuse cytoplasmic positivity in all tumor cells. (D) Immunostaining for PRAME (10 x magnification) showing diffuse nuclear positivity in all tumor cells.
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F2
As a result, the patient underwent an incisional biopsy of the right axillary nodule, with formalin-fixed paraffin-embedded (FFPE) samples revealing malignant cells within fibroadipose tissue (Figure 2).
Timeline of the patient's clinical course and melanoma-directed therapy. CVT, Cisplatin/vinblastine/temozolomide; IPI, Ipilimumab; M1D, Metastasis to the central nervous system, with or without involvement of other sites; NIVO, Nivolumab; PD, Progressive disease; RELA, Relatlimab; SD, Stable disease; SB, Small bowel; TIL, Tumor-infiltrating lymphocytes.
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F3
Figure 3 showcases a timeline with relevant data from the patient's clinical course.