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CASE REPORTS
Year : 1999  |  Volume : 65  |  Issue : 6  |  Page : 298-300

Tumour implantation on a donor site from malignant melanoma of the right arm: a rare clinical entity




Correspondence Address:
M Gairola


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Source of Support: None, Conflict of Interest: None


PMID: 20921695

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How to cite this article:
Gairola M, Sriram V, Sharma D N, Mohanti B K, Rath G. Tumour implantation on a donor site from malignant melanoma of the right arm: a rare clinical entity. Indian J Dermatol Venereol Leprol 1999;65:298-300

How to cite this URL:
Gairola M, Sriram V, Sharma D N, Mohanti B K, Rath G. Tumour implantation on a donor site from malignant melanoma of the right arm: a rare clinical entity. Indian J Dermatol Venereol Leprol [serial online] 1999 [cited 2019 Oct 22];65:298-300. Available from: http://www.ijdvl.com/text.asp?1999/65/6/298/4848





  Introduction Top


Tumour implantation is a recognised clinical entity. Great care is taken to excise previous biopsy incisions, remove contaminated instruments from the field of surgery and irrigate the wound before closure.[1] Inappropriate handling of the tumour at the time of primary surgery can lead to implantation of malignant cells. We hereby present an unusual case of malignant melanoma of right upper limb, recurring on the anterior abdominal wall subsequent to a radical excision followed by reconstructive surgery.


  Case Report Top


A 28-year-old man presented in June 1997 with an above elbow amputation of right arm and a non healing ulcer on the anterior abdominal wall of the right iliac fossa [Figure - 1]. The patient gave a history of a non healing ulcer on the palmar aspect of the right wrist joint of approximately 6x6 cm in size of three months duration. At a secondary level hospital, biopsy revealed a malignant melanoma. A wide local excision with reconstruction of a cutaneous flap from the anterior abdominal wall to the site of excision was performed. A recurrence of a rapidly increasing ulceroproliferative growth on the whole of the palmar aspect of the wrist, resulted in the treating surgeon performing an above elbow amputation of the right side. The patient was then referred to our institute for the management of progressively increasing non healing ulcer at the donor site of reconstructive surgery, on the anterior abdominal wall.

Examination revealed a 5x5 black nodular growth on the abdominal wall surrounded by a hypertrophic scar with underlying induration [Figure - 2]. Swelling was non tender and fixed to the anterior abdominal wall, located in the right iliac region.

Biopsy from the non healing ulcer revealed malignant melanoma, consistent with the histology of primary tumor. Complete metastatic work up of the patient including complete haemogram, liver and renal function tests, X-ray chest and ultrasound of abdomen and pelvis were all within normal parameters. Thus, in view of the presenting history, a thorough clinical examination and investigation, a diagnosis of tumor implantation at the donor graft site was made and was treated accordingly.

He was treated by a short course of palliative radiotherapy to the anterior abdominal wall. 500cGy per fraction weekly for 4 weeks were delivered by a telecobalt unit. He noticed significant pain relief and excellent resolution of the tumor. The patient is presently alive at the end of six months of follow up.


  Discussion Top


Tumour implantation is an infrequent occurrence, but has never been reported for malignant melanoma.

Implantation occurring during tumour surgery and flap reconstruction is particularly uncommon. Sherman et al,[2] described implantation of fibrosarcoma to the donor site using a cross leg flap. The case of Mohaffy et al,[3] involved tumour occurring at the base of a deltopectoral flap used to reconstruct an incompletely excised oral carcinoma.Saphir[4] had demonstrated that apparently viable tumour cells could be collected from the scalpel used to cut into breast carcinoma. Safour et al[5] proved the theory that scalpel used to perform biopsy in a hamster pouch carcinoma is universally contaminated with malignant cells.

Tracheostomy site recurrence after total laryngectomy is a well known and a fatal complication that ocurs in 3% to 40% of the patients.[6] Cutaneous implantation is now a recognised complication of percutaneous diagnostic needle biopsy.[7] Tumor implantation at the donor site or tracts in case of malignant melanoma is quite rare in clinical practice. Quantification of tumour seeding from fine needle aspiration in ocular melanomas revealed that the amount deposited in the tracts was not sufficient to be associated with tumour growth in experimental models.[8]

It is suggested that great caution is needed while performing the cancer surgery, by removing the contaminated instruments, in order to reduce the risk of tumor implantation or seeding.



 
  References Top

1.Alagratnam TT, Ong GB. Wound implantation-a surgical hazard. Br J Surg 1977;64:872-875.  Back to cited text no. 1    
2.Sherman JE, Urmacher C, Lane J, et al. The use of cross leg flap in malignancy: Realization of a potential complication. Plast Reconst Surg 1981;67:230-233.  Back to cited text no. 2  [PUBMED]  
3.Mahhafay PJ, Sommrland BC. Tumor spread in a deltopectoral pedicle flap used in reconstruction of lower jaw: Case report. Br J Plast Surg 1985;38:43-45.  Back to cited text no. 3    
4.Saphir O. The transfer of tumor cells by the surgical knife. Surg Gynaecol Obst 1936;63:775-776.  Back to cited text no. 4    
5.Safour IM,Wood NK, Tsiklakis K, et al. Incisional biopsy and seeding in hamster cheek pouch carcinoma. J Dent Res 1984;63:1116-1120.  Back to cited text no. 5  [PUBMED]  
6.Davis KR, Shapsay MS. Peristomal recurrence: Pathophysiology, prevention, treatment. Otolaryngol Clin North America 1980;13:499-508.  Back to cited text no. 6    
7.Ferruci JT, Wiffenberg J, Margolies MN. Malignant seeding of the tract after thin needle aspiration biopsy. Radiology 1979;130:345-346.  Back to cited text no. 7    
8.Glasgow BJ, Brown H, Zargoza AM, et al. Quantification of tumour seeding from fine needle aspiration of ocular melanomas. Am J Opthalmol 1985;105:538-546.  Back to cited text no. 8    


    Figures

[Figure - 1], [Figure - 2]



 

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