Lower Extremity Amelanotic Nodular Melanoma

Case Report

Austin J Emergency & Crit Care Med. 2014;1(2): 3.

Lower Extremity Amelanotic Nodular Melanoma

Khishfe BF*, Krass LM and Nasr I

Department of Emergency Medicine, Cook County (Stroger) Hospital, USA

*Corresponding author: Khishfe BF, Department of Emergency Medicine, Cook County (Stroger) Hospital, 1900 W Polk St Admin bldg, 10th floor, Chicago, Il 60612, USA

Received: November 24, 2014; Accepted: December 24, 2014; Published: December 27, 2014


The incidence of melanoma has increased 15-fold in the past 40 years, which is more rapid than for any other malignancy. Nodular melanoma is the second most common subtype of melanoma and is often diagnosed at more advanced stages. Nodular melanoma contributes disproportionately to the number of deaths from melanoma. We discuss the case of a patient presenting with large amelanotic nodular melanoma of the lower extremity that had progression of disease despite undergoing appropriate management. It is important for Emergency physicians to maintain a high level of suspicion for nodular melanoma given the high mortality rates associated with this malignancy.

Keywords: Nodular; Cutaneous; Melanoma


Melanoma is the fifth most common type of cancer, representing 4.6% of all new cancer diagnoses in the United States [1]. Primary cutaneous melanoma is classified into four sub-types: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma [2]. Nodular melanoma is an aggressive tumor that exhibits early rapid growth and advanced thickness at time of diagnosis [3-4]. We describe a case of a patient with a large primary cutaneous nodular melanoma of the lower extremity with advanced metastatic disease.

Case Presentation

The patient is a 55-year-old male, with past medical history significant for hypertension, hypercholesterolemia, and diabetes mellitus. He presented to the Emergency Department with a large, fungating mass on his right lower extremity for 3 months. The mass had grown rapidly and became ulcerated with occasional bleeding and clear discharge. He denied any significant pain or neurological symptoms. The patient reported additional symptoms of fatigue and anorexia but denied any significant weight loss.

The physical examination revealed a 7 x 5 cm ulcerated, exophytic mass of the lower third anterior aspect of the right leg composed of amelanotic, beefy red tissue with yellow fibrinous granulation tissue and an 8 mm pink papule just proximal to the lesion (Figure 1). A full-body skin examination revealed large right inguinal lymphadenopathy; no left inguinal or axillary lymphadenopathy was noted.

Citation: Khishfe BF, Krass LM and Nasr I. Lower Extremity Amelanotic Nodular Melanoma. Austin J Emergency & Crit Care Med. 2014;1(2): 3 ISSN:2380-0879