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A Possible Diagnostic Clue for Physicians

Stephanie Hu, BS; Caroline C. Kim, MD; Chad Jessup, MD; Thuy L. Phung, MD, PhD; Clara Curiel-Lewandrowski, MD

Arch Dermatol. 2009;145(5):565-568.

Background  In addition to a complete skin examination every few months, adjuvant interferon treatment is often recommended for patients with high-risk melanomas. Therefore, dermatologists play an important role in detecting multiple primary melanomas and may be required to attempt to identify the primary melanoma in patients with metastatic disease.

Observations  We describe 3 patients with a diagnosis of melanoma who were diagnosed as having a new primary cutaneous melanoma within weeks of initiating interferon treatment. All 3 melanomas were inflamed clinically, prompting excisional biopsy. Histopathologic analysis of the melanomas revealed thin (<1.0 mm Breslow thickness) invasive tumors, as well as the presence of tumor-infiltrating lymphocytes and/or regression.

Conclusions  Inflamed melanocytic lesions in patients undergoing interferon treatment should be further evaluated to investigate the possibility of primary cutaneous melanomas. This observation may enable earlier detection and treatment of melanomas in patients with multiple tumors or metastatic melanoma with an unknown primary site.

Author Affiliations: Harvard Medical School (Ms Hu and Drs Kim, Jessup, and Phung); and Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology (Dr Kim), and Department of Pathology (Drs Jessup and Phung), Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Pigmented Lesion Clinic and Cutaneous Oncology Program, Arizona Cancer Center, and Section of Dermatology, University of Arizona,Tucson (Dr Curiel-Lewandrowski).

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