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Giant Melanomas
Dylan Childs MD, Vidya Shankaran MD, Gary Pennington MD
Akron CIty Hospital
2014-03-15
Presenter: Dylan Childs
Affidavit:
100% performed by the residents
Director Name: Douglas Wagner
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Melanoma remains a disease that is both a challenge in diagnosis and screening as well as treatment. With both the incidence and prevalence increasing recognition of diagnostic clues must be used as well as identifying patients at higher risk. Currently screening guidelines focus on patients with personal or family history and sun exposure. However as more therapies begin to identify targets to prevent anergy of the immune system, should patients on immune suppression have increased surveillance for melanoma?
Case Presentation:
We report two cases of large melanomas one occurring on the scalp the other on the upper extremity. The initial patient was an 84 yo male with heart disease and severe COPD on steroids for years. He presented with a 4 month history of a large pigmented lesion involving nearly 1/2 of the scalp extending behind the ear with satellite lesions. No nodes were palpable on exam and biopsy revealed a 1.8 mm melanoma. The second patient was an 81 yo male with a history of pulmonary fibrosis on steroids that presented with a 2 month history of a large pigmented lesion on his right forearm with irregular margins and satellite lesions. On biopsy patient was found to have a 4 mm melanoma.
Discussion:
Both of these patients presented with rapidly growing cutaneous lesions that turned out to be fatal. As surgical resection remains a mainstay of treatment do patients on immune-suppressants require more aggressive surveillance?
