Big, Hairy and Scary: Congenital Melanocytic Nevus with Malignant Melanoma

Authors: Katrina April M. David, MD, Fatima Jacinto-Calimag, MD, Ma. Angela M. Lavadia, MD, FPDS

Abstract

Introduction: Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes clinically apparent at birth or within the first postnatal weeks. As diameter increases, the potential for malignant transformation follows usually around the periphery of a flat Congenital melanocytic nevi.

Case Summary: We have a 25-year old Filipino female who presented at birth with a dark-brown patch on the right thigh. At puberty, there was increase in size with cobblestone-like globules within the nevus. There was no associated bleeding and tenderness. Ten months prior, patient developed a slowly growing 2-cm darkly pigmented nodule within the central portion of the nevus this time accompanied with ulceration and bleeding after repetitive trauma. Cutaneous examination showed Several, well-defined, irregularly shaped, papules coalescing into plaque with cobblestone like globules and hypertrichosis around the periphery of the nevus measuring 15cm x 9cm and a darkly pigmented, nodule on the central portion of the nevus with a rim of grey ulceration measuring 2×2 cm over the right thigh. Incision biopsy on the nevus revealed Malignant Melanoma arising within a congenital nevus, most probably invasive to anatomic level IV. Patient underwent Wide excision of melanoma to the muscle fascia with inguinal lymph node dissection and Split thickness skin graft. Lymph node biopsy revealed Breslow’s thickness 4.0 mm. Pathologic stage IIIC.

Conclusion: Malignant Melanoma in a congenital nevus can pose as a challenge in definite diagnosis and management. Incision biopsy along with extensive work-up is essential to to arrive at the proper dermatological diagnosis and rule out extracutaneous involvement.

 

Citation

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Keywords

Congenital Melanocytic Nevi, Medium sized nevi, malignant melanoma

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