Melanoma Neglecta

Presented by Jorge Delgado, M.D.
Brownsville, Texas

 

The patient is a single 65 yo man who lives alone.  He does not have a physician and has received no medical care in years.  His sister, who lives outside of the country, came to visit and noted that his shirts were stained by a malodorous exudate of blood and pus. Questioning, led to the discovery of a tumor on his back that apparently had been growing for months to years.

 

Usually fastidious about his personal hygiene, she also observed that he’d become forgetful, unsteady on his feet and had fallen recently.

 

The examination showed a 5 cm tumor on his back, portions of which had ulcerated.  No pigment was discernable.

 

 

She took him to a dermatology clinic where a biopsy was done.  It was reported as melanoma, greater than 4 mm thick with many mitoses.  We don’t have the path report.

 

This represents an example of Melanoma Neglecta.  People who lack basic medical care, who are isolated or who live in undeserved areas are recognized to be at risk for tumors that are detected at a late stage.

 

References:

1. Ana-Maria Forsea. Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities. Dermatol Pract Concept. 2020 Jun 29;10(3):e2020033.  PMC

 

2. Sauaia A , Dellavalle RP. Health care inequities: an introduction for dermatology providers. Dermatol Clin. 2009 Apr;27(2):103-7, PMC

 

3. Rachidi S, Deng Z, Sullivan DY , Lipson EJ. Shorter survival and later stage at diagnosis among unmarried patients with cutaneous melanoma: A US national and tertiary care center study. J Am Acad Dermatol. 2020 Oct;83(4):1012-1020.
Conclusions: Unmarried patients, especially men and those younger than 68 years, are diagnosed at more advanced stages, even in readily visible sites such as the face. They also experience worse survival independent of stage.