The patient is a 80-year-old man who presented with swelling of the left leg for 3 months.
On examination his left leg was swollen and oedematous with many pigmented papules and nodules on the foot and lower 1/3 of the left leg. A pigmented ulcerating tumour 5 x 5 cm was noted on the left foot which extended to the heel. A firm matted lymph node swelling was noted on the left groin. There was a surgical scar over the left groin. No hepatosplenomegaly was present.
Biopsy of the pigmented papule on the foot was done and confirmed malignant melanoma.
Sheets and nests of malignant cells are seen invading the dermis. The tumour cells show marked pleomorphism, have increased nucleo-cytoplasmic ratio, vesicular nuclei with prominent nucleoli and eosinophilic cytoplasm. Many of the cells contain melanin pigment. Numerous mitotic figures are seen. The tumour is seen at the margins. Masson Fontana stain is focally positive.
Skin biopsy Report: Features are consistent with malignant melanoma.
His work up included an oncology referral. CT scan of abdomen and pelvis which showed pelvic and para-aortic lymph node metastasis. CXR normal. TWBC was 16,400. BRAF gene mutation studies pending