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Year : 1997  |  Volume : 63  |  Issue : 5  |  Page : 327-329

Nodular malignant melanoma - Secondary to carcinoma rectum

Correspondence Address:
Adarsh Chopra

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Source of Support: None, Conflict of Interest: None

PMID: 20944369

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A 45-year female presented with a sudden eruption of multiple brownish black nodular lesions since 5 months over the face, trunk and extremities which were clinically diagnosed as a case of nodular malignant melanoma. Histopathologically, they revealed the secondaries from carcinoma rectum.

Keywords: Melanoma, Nodular, Rectum, Malignant

How to cite this article:
Chopra A, Walia R, Gupta S, Sethi P S, B. Nodular malignant melanoma - Secondary to carcinoma rectum. Indian J Dermatol Venereol Leprol 1997;63:327-9

How to cite this URL:
Chopra A, Walia R, Gupta S, Sethi P S, B. Nodular malignant melanoma - Secondary to carcinoma rectum. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2020 Jul 4];63:327-9. Available from:

Cutaneous metastasis is rare with the skin being regarded as the 18th most frequent site for all tumour types.[1] The incidence of cutaneous metastasis ranges from less than 1% to approximately 5%.[2] The cutaneous metastases arising from various malignancies include carcinoma lung (14%), oesophagus (8%), stomach (6%) and melanoma (6%).[3] Malignant melanomas (MM) are the tumours arising from the epidermal melanocytes.[4] In 1969, Clark using a combination of clinical and pathological features, classified MM into four types out of which nodular variety is rare.[5] Characteristic clinical features of MM Include variegation in colour, asymmetry of the lesion, an irregular perimeter with indentations, an irregular raised surface, ulceration of the surface epithelium and crusting.[6] Histopathologically, the tumour originates almost invariably at the dermo-epidermal junction and junctional activity is irregular with downward streaming from the epidermis into the dermis of tumour cells possessing anaplastic nuclei.[7] Out of all MM, nodular melanoma carries a poorer prognosis because of vertical spread and more rapid invasion.[8] The treatment of primary cutaneous melanoma is by surgical excision but patients with disseminated secondary melanoma have a poor prognosis and chemotherapy is given only for symptomatic relief.[9]

  Case Report Top

A 45-year-old nulliparous female presented to us with a history of sudden onset of multiple, pigmented nodular lesions on head and neck, face, trunk back and left thigh for last 5 months, and history of constipation, passing of blood after defaecation and loss of appetite for last 2 years. Examination revealed both cutaneous and subcutaneous forms of nodules of 0.2-3cm in sizes, soft, reddish brown to black, pedunculated and slightly tender with a few lesions showing superficial ulceration and bleeding. Subcutaneous nodules were mobile, dome shaped reddish-brown with smooth surface. Perrectal examination revealed rectal growth through which sigmoidoscope could not be passed. The routine lasoratory tests on blood, urine and stools were normal except raised ESR (41mm/1st h). Blood urea and blood sugar values were normal; serum alkaline phosphatase was 108 iu/L, SGPT 28 iu/L, ELISA for HIV was negative. X-ray of the chest showed multiple rounded opacities in both lung fields suggestive of secondaries. USG for abdominal and pelvic organs were normal and no mass could be detected. Skin biopsy from fully developed nodular lesion revealed deposit of MM, nodular variety as there was thinning of the epidermis by aggregates of atypical melanocytes within the dermis along with inward turning of the rete ridges, which revealed to be of secondary origin. Biopsy from rectal growth revealed mucosa infiltrated with mononuclear cells and atypical cells along with atypical melanocytes similar to as seen in skin biopsy.

Patient was given chemotherapy in the form of 5-fluorouracil 1gm daily for 3 consecutive days and course repeated after 28 days, Ulceration and bleeding decreased and there was no increase in size of the lesions. Patient was followed up for 3 months, but after 3 months patient never reported to us.

  Discussion Top

Nodular melanoma is a rare variant of MM but secondaries from carcinoma rectum in the form of nodular MM is still rarer. Course of the disease was widespread when patient reported to us because of pulmonary and cutaneous metastases but still chemotherapy proved to be a mild benefit to the patient. Prognosis of such type of patient is generally poor.

  References Top

1.Abram HL, Spro R, Goldstein N. Metastases in carcinoma, Cancer 1953,3:74-85.  Back to cited text no. 1    
2.Shanmugham SM. Carcinoma \ill\ with cutaneous metastases. Ind J Dermatol Venereol Leprol 1897;53:357-359.  Back to cited text no. 2    
3.Tharakaram S. Pattern of cutaneous metastases. Ind J Dermatol Venereol Leprol 1986;52:149-151.  Back to cited text no. 3    
4.Rook A, Wilkinson DS, Ebling FJG, et al: Malignant melanoma, in : Textbook of Dermatology, 5th Edn. Blackwell Scientific Publications, oxford 1992;1545-1560.  Back to cited text no. 4    
5.Clark WH, From L, Bernardino EA, et al. The histogenesis and biologic behaviour of primary human malignant melanomas of the skin. Cancer Res 1969;29:705-726.  Back to cited text no. 5    
6.Mackie RM, Young D. Human malignant melanoma. Int J Dermatol 1984;23:433-443.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Lever WF, Lever GS. Malignant melanoma in : Histopathology of Skin 7th edn, Lippincott Company, 1990;785-796.  Back to cited text no. 7    
8.Weinstock MA. Morris BT, Lederman JS, et al. Effect of BANS location on the prognosis of clinical stage 1 melanoma : New data and meta-analysis, Br J Dermatol 1988;119:559-565.  Back to cited text no. 8    
9.Ho VC, Sober AJ. Therapy for cutaneous melanoma : An update. J Am Acad Dermatol 1990;22:159-177.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]


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