Nodular Malignant Melanoma Presenting as a Rapidly Growing Pigmented Skin Lesion: A Case Report

Nodular variant of malignant melanoma is a highly aggressive neoplasm arising from melanocytes, accounting for the majority of skin cancer related deaths despite its relatively low incidence. Hereby, the authors present a case of a 68-year-old male patient presented with 10 months history of pigmented nodule with ulceration over left supraclavicular region which gradually increasing in size. There was no any positive family history of similar lesion. Routine haematological and biochemical reports did not show any significant abnormality. Contrast-enhanced Computed Tomography (CT) scan of the thorax revealed a well-defined irregularly marginated heterogeneously enhancing soft-tissue lesion measuring 2.7×1.7×1.6 cm approximately involving left supraclavicular region. For the present particular case, the patient did not undergo prior biopsy procedure. Patient had a wide local excision and condition was determined to be nodular type of malignant melanoma after histopathological examination. Histopathological examination showed high breslow thickness, microsatellitosis, tumour infiltrating lymphocytes, high mitotic rate, focal regression. In the absence of histological confirmation of distant metastasis, the pathological primary tumour category was assigned as pT4b based on the primary tumour characteristics. Following surgical excision, the patient was referred to a tertiary oncology centre for B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600 mutation testing and further oncological management. Given the high-risk pathological features, adjuvant anti-PD-1 immunotherapy was considered. As Nodular Malignant Melanoma (NMM) is a malignant neoplasia with high rate of mortality and bad prognosis, prompt diagnosis is paramount for physicians to start an aggressive treatment. The present case showed the highly aggressive nature of NMM demonstrating multiple adverse prognostic features.