Generalized lymphadenopathy as the first manifestation of metastatic malignant melanoma: a diagnostic paradox

Abstract

Background: Although more than 90% of melanomas have cutaneous origin, there are a few cases who present with lymph node disease or metastatic viscera lesions, with no identifiable primary, described as melanomas of unknown primary site.

Case Report: We report a case of a morbidly obese 63-year-old male, with multiple comorbidities, who presented with neurological symptoms and extensive lymphadenopathy was revealed on clinical examination and on imaging. Excisional biopsy of a supraclavicular nodal mass followed and histopathological examination with the aid of immunohistochemistry lead to the diagnosis of metastatic malignant melanoma. Despite investigations the primary tumor site remained unrevealed and the patient received palliative chemotherapy.

Discussion: Generally, melanomas evolve from any site of the body containing melanocytes or cells that are capable of differentiating into melanocytes, although cases without an identifiable cutaneous, ocular, or mucosal primary, claimed as melanomas of unknown primary, comprise only 1-4% of melanoma cases per year. Extensive work-up sometimes seem meaningless. It is also stated that such patients with lymph nodal disease, despite the unfavorable sign of nodal involvement fare better survival rates than common patients with known primary and lymph nodal metastasis.