HPI: An 72-year-old Indian housewife present with a pigmented growth on the right sole for a year. Started as a small growth and gradually increased in size. She saw a GP earlier and was advised to remove it. However she was not keen then. Recently she felt pain when she walked and this prompted her to seek medical attention again.
O/E: An ulcerated pigmented warty growth 2 x 3 cm on the sole of the right foot with surrounding pigmented satellite lesions. Her regional nodes
(popliteal and inguinal) were not enlarged.
Nests of atypical cells are seen in the epidermis and dermis. Most of the cells contain melanin pigment. They show pleomorphism, have vesicular nuclei and eosinophilic cytoplasm. These features are suggestive of malignant melanoma. Suggest wide excision for definite diagnosis.
Diagnosis: Malignant melanoma, acral lentiginous type with nodular component.
How would you approach this patient?
Do you think Sentinel Lymph Node Biopsy is important in her case?
What would give her the best quality of life?
After surgery, is there a role for topical imiquimod?
1) Kanzler MH. Sentinel node biopsy and standard of care for melanoma: a re-evaluation of the evidence. J Am Acad Dermatol. 2010 May;62(5):880-4.
2) No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial-I final report. Sladden M1, Zagarella S, Popescu C, Bigby M. Br J Dermatol. 2015 Mar;172(3):566-71. PubMed.
3) Aral lentiginous melanoma treated with topical imiquimod cream: possible cooperation between drug and tumour cells.