|Year : 1994 | Volume
| Issue : 5 | Page : 308-309
Pedunculated malignant melanoma
M Bhat Ramesha, S Sachidanand, John Stephen
M Bhat Ramesha
Source of Support: None, Conflict of Interest: None
Pedunculated malignant melanoma is a rare occurrence. A 29 year old woman presented with a pedunculated malignant melanoma on a congenital melanocytic naevus with halo. Pedunculated malignant melanoma is known to have a high incidence of metastasis. The absence of metastasis and the presence of halo, in the case presented, suggests, that the body's immunological process may have arrested the spread of the melanoma.
Keywords: Pedunculated malignant melanoma, Congenital melanocytic naevus, Halo naevus
|How to cite this article:|
Ramesha M B, Sachidanand S, Stephen J. Pedunculated malignant melanoma. Indian J Dermatol Venereol Leprol 1994;60:308-9
| Introduction|| |
Pedunculate or polypoidal malignant melanoma is defined as exophytic lesion that clinically and / or histologically possessed a stalk or has a base that is narrower than some portion of the tumor mass above it.  It is found most frequently on the trunk.  Though there are several reports of pedunculated malignant melanoma, it certainly is not common. We report a patient with pedunculated malignant melanoma on a congenital melanocytic naevus with halo.
| Case Report|| |
A 29-year-old woman presented with a slowly enlarging black lesion on her back of 9 months duration. The nodule started on a black mole which was present since birth. She had used native medicine in the form of local application 2 weeks prior to reporting. The surface of the growth developed erosions and mild burning sensation was experienced following the application.
On examination a 7 x 5 x 4 cm 3 size pedunculated reddish purple nodule was seen in the lumbosacral region in the midline. Few erosions were seen on the surface of the protruding nodule. The stalk was seen to arise from a melanocytic naevus of 1.5 cm in diameter with irregular borders. Surrounding the naevus was a halo of depigmented area extending about a millimeter from the edge of the naevus [Figure - 1]. There was no evidence of lymph node, visceral or bone involvement.
A total excision biopsy with a narrow margin was performed. The primary lesion was purple red and had a pedunculated configuration. On cross section, the tumor was grey black with a narrow cuffed base sharply demarcated by the absence of pigment. Histopathological examination of the nodule revealed nests and sheets of cells with plemorphic nuclei [Figure - 2]. Many cells contained melanin granules. Focally, many portions of the overlying epidermis were ulcerated.
| Comments|| |
The pedunculated growth pattern of melanoma was first mentioned in the literature by Vogler and associates in 1958.  Later Shapiro and Bodian reported 2 cases of pedunculated malignant melanoma .  Since then there are several reports. Malignant melanoma dveloping in a giant congenital melanocytic naevus is well documented. On the other hand malignant melanoma on small congenital melanocytic naevus less than 10 cms in diameter is regarded as relatively harmless. In cur patient, the pedunculated malignant melanoma was present not just on a congenital melanocytic naevus but on a naevus with halo. While a considerable reports has been published on the halo naevus phenomenon, only few reports deal with a halo naevus in association with malignant melanoma. Copeman et a1 sub on discovery of an antigenic link between the halo naevus and malignant melanoma, raised the possibility that the phenomenon seen in the benign halo naevus may be a manifestation of rejection of an early malignant melanoma.
A pendunculated malignant melanoma on a congenital melanocytic naevus with halo to the best of our knowledge has not been reported. The absence of metastasis, the presence of halo suggests an attempt by the immunological process of the body, at rejection of the melanoma.
| References|| |
|1.||Reed K M, Bronstein BR, Mihm MC Jr, et al. Prognosis for polypoidal melanoma is determined Ly primary tumor thickness. Cancer 1986; 57: 1201-3. |
|2.||Manci EA, Balch CM, Murad TM, et al. Polypoid melanoma, a virulent variant of the nodular growth pattern. AmJ Clin Path 1981; 75: 810-15. [PUBMED] |
|3.||Vogler WR, Perdue GD, Wilkine SA. A clinical evaluation of malignant melanoma. Surg Gynecol Obstet 1958; 106: 586-94. |
|4.||Shapiro L, Bodian EL. Malignant melanoma in the form of pedunculated papules. Arch Dermatol 1969; 99: 49-50. [PUBMED] |
|5.||Copeman PWM, Lewis MG, Phillips TM, et al. Immunological associations of the halo naevus with cutaneous malignant melanoma. Br J Dermatol 1973; 88: 127-37. |
[Figure - 1], [Figure - 2]