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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 6  |  Page : 238-240

A report of a rare case of breast metastasis from cutaneous malignant melanoma


1 Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
2 Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication18-Jan-2019

Correspondence Address:
Dr. Anirban Halder
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccij.ccij_44_18

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  Abstract 


Benign and primary malignant breast tumors are rather common, but secondary tumors in the breast from extramammary malignancies are uncommon. Breast metastases from melanoma are rare but could reflect a widespread disease. We present a case of melanoma of the right lateral chest wall with metastasis to the right breast and subcutaneous tissue in a postmenopausal female. She was planned for palliative chemotherapy with cisplatin and dacarbazine. Interim imaging after three cycles of chemotherapy showed stable disease. The long-term prognosis of patients with breast metastasis from malignant melanoma is extremely unfavorable.

Keywords: Breast metastasis, melanoma, postmenopausal


How to cite this article:
Halder A, Yadav V, Shukla S, Biswas R, Kaur J. A report of a rare case of breast metastasis from cutaneous malignant melanoma. Clin Cancer Investig J 2018;7:238-40

How to cite this URL:
Halder A, Yadav V, Shukla S, Biswas R, Kaur J. A report of a rare case of breast metastasis from cutaneous malignant melanoma. Clin Cancer Investig J [serial online] 2018 [cited 2019 Oct 17];7:238-40. Available from: http://www.ccij-online.org/text.asp?2018/7/6/238/250403




  Introduction Top


Malignant melanoma is one of the most rapidly increasing neoplasms in frequency in the world.[1] Hematogenous or lymphatic metastases from malignant melanoma occur in 20% of cases. Liver, lung, and brain are the common sites of hematogenous metastases although any organ can be involved.[1] Involvement of the breast by metastatic melanoma is hardly reported, resulting in its very rare clinical consideration.[2] The breast metastatic melanoma can present as a solitary lesion or as multiple unilateral or bilateral masses, which could be palpable clinically or just incidental findings on imaging.[3] The correct management of metastatic disease to the breast can prevent unnecessary mutilation.[4] We present a case of melanoma of the right lateral chest wall with metastasis to the right breast and subcutaneous tissue in a postmenopausal female.


  Case Report Top


An otherwise well, 55-year-old postmenopausal female presented to us with a history of a right lateral chest wall lump for 3 months. On examination, there was a 12 cm × 8 cm lump with irregular surface and skin pigmentation over the lower-outer quadrant of the right breast and right lateral chest wall. Another small nodule was seen at the right lower back [Figure 1]. She was operated twice for the same mass at a peripheral center in the last 1 year, details of which were unavailable. Trucut biopsy from the right chest wall mass was suggestive of malignant melanoma [Figure 2]. On immunohistochemistry (IHC), the tumor cells were positive for HMB-45 and S-100 [Figure 2]. Contrast-enhanced computed tomography (CECT) scan of the thorax and abdomen and contrast-enhanced magnetic resonance imaging (CEMRI) of the right breast revealed a 32 mm × 19 mm, well-defined, intensely enhancing heterogeneous mass lesion in the right posterolateral chest wall with a large-lobulated, intensely enhancing, well-defined mass lesion (8.2 cm × 4.3 cm × 7.8 cm) in the right breast with few subcutaneous metastatic deposits in the right lower back, suggestive of recurrent mass lesion (primary) in the right posterolateral chest wall with metastatic mass in the right breast and subcutaneous deposits in the right lower back. The mass lesion in the right breast was hyperintense on T1 and isointense on T2, with intense heterogeneous enhancement on postcontrast. The lesion showed restricted diffusion on diffusion-weighted imaging (DWI) [Figure 3]. CEMRI of the brain showed no focal lesions in the brain. The patient was planned for palliative chemotherapy with cisplatin and dacarbazine. Interim CECT scan of the thorax and abdomen after three cycles of chemotherapy showed stable disease [Figure 4].
Figure 1: (a) Lump with irregular surface and skin pigmentation over the lower-outer quadrant of the right breast and right lateral chest wall and (b) another small nodule at the right lower back

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Figure 2: (a) Histopathology suggestive of malignant melanoma, (b) the tumor cells staining positive for HMB-45 and (c) S-100

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Figure 3: (a) Contrast-enhanced computed tomography scan of the thorax and abdomen revealed well-defined, intensely enhancing heterogeneous mass lesion in the right posterolateral chest wall (coronal view), (b) contrast-enhanced magnetic resonance imaging of the right breast revealed large-lobulated, intensely enhancing, well-defined mass lesion in the right breast, and (c) few subcutaneous metastatic deposits in the right lower back

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Figure 4: (a and b) Contrast-enhanced computed tomography scan of the thorax and abdomen after three cycles of chemotherapy showed stable disease

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  Discussion Top


Breast represents an unusual site of metastatic disease from extramammary tumors.[5] Variable origins of metastases to the breast are represented by lymphomas, melanomas, rhabdomyosarcomas, and lung and ovarian tumors.[6] Breast metastases from melanoma usually occur in premenopausal and considerably younger women. In half of the cases, the upper-outer quadrant of the breast is involved.[7] In contrast, our patient was a postmenopausal female and the breast mass was present in lower-outer quadrant of the right breast. Melanoma exhibits the typical signal intensity on MRI. Melanoma contains a melanin component that contains stable-free paramagnetic radicals, resulting in high signal on T1-weighted images and a low signal on T2-weighted images on MRI. On DWI, melanoma generally shows diffusion restriction and enhances after gadolinium-based contrast agent administration.[8] Our patient had similar radiological characteristics.

In most cases, metastatic melanoma can mimic a variety of cellular and architecture makeup, including primary breast malignancies. IHC allows a correct diagnosis; tumor cells are positive for S-100 protein, melan-A, and HMB-45, along with no expression for cytokeratin staining, hence helping in differentiating malignant melanoma from other malignant tumors.[9] Treatment options for metastatic melanoma include close observation, surgical resection of isolated metastases, chemotherapy, and radiation therapy.[1] Breast metastases indicate a disseminated disease and aggressive surgical procedures should be avoided in view of poor prognosis.[1]


  Conclusion Top


Breast metastasis from extramammary malignancy is very rare. Generally speaking, in a setting of melanoma, as in our case, these lesions reflect wide disseminated disease and prognosis is extremely unfavorable.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Moschetta M, Telegrafo M, Lucarelli NM, Martino G, Rella L, Stabile Ianora AA, et al. Metastatic breast disease from cutaneous malignant melanoma. Int J Surg Case Rep 2014;5:34-6.  Back to cited text no. 1
    
2.
Bahat G, Colak Y, Saka B, Karan MA, Buyukbabani N. Melanoma metastasis to the breast: A diagnostic pitfall. Cancer Detect Prev 2009;32:458-61.  Back to cited text no. 2
    
3.
Prvulović N, Đilas-Ivanović D, Nikolin B, Stojiljković B. Melanoma metastatic to the breast: A report of an unusual case. Arch Oncol 2011;19:79-80.  Back to cited text no. 3
    
4.
Majeski J. Bilateral breast masses as initial presentation of widely metastatic melanoma. J Surg Oncol 1999;72:175-7.  Back to cited text no. 4
    
5.
Yang WT, Muttarak M, Ho LW. Nonmammary malignancies of the breast: Ultrasound, CT, and MRI. Semin Ultrasound CT MR 2000;21:375-94.  Back to cited text no. 5
    
6.
Vizcaíno I, Torregrosa A, Higueras V, Morote V, Cremades A, Torres V, et al. Metastasis to the breast from extramammary malignancies: A report of four cases and a review of literature. Eur Radiol 2001;11:1659-65.  Back to cited text no. 6
    
7.
Al-Zawi AS, Osayi K, Eades J. Breast metastasis from a malignant melanoma – A case Report. Int J Radiol Radiat Ther 2017;3:62.  Back to cited text no. 7
    
8.
Kim Y, Cho KR, Kyoung SB, Woo OH, Lee JH, Cho SB. Radiologic findings of metastatic malignant melanoma of the breast: Mammographic, sonographic, dynamic contrast-enhanced breast MRI, and 18F-FDG PET-CT features. Iran J Radiol 2017;14:e38392.  Back to cited text no. 8
    
9.
Bacchi CE, Wludarski SC, Ambaye AB, Lamovec J, Salviato T, Falconieri G, et al. Metastatic melanoma presenting as an isolated breast tumor: A study of 20 cases with emphasis on several primary mimickers. Arch Pathol Lab Med 2013;137:41-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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