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Clinicopathologic features and surgical management of primary umbilical melanoma: a case series.

Di Monta G, Caracò C, Marone U, Grimaldi AM, Anniciello AM, Di Marzo M, Simeone E, Mori S - BMC Res Notes (2015)

Bottom Line: Sentinel lymph node biopsy was negative in two cases.Two of the patients developed metastatic disease and died after systemic medical therapy.The other patient is currently in follow-up, and remains disease-free after 21 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy. gidimonta@libero.it.

ABSTRACT

Background: Primary umbilical melanoma is an uncommon tumor that is poorly described in the medical literature. The umbilical region is a particular anatomic site owing to the presence of embryonal remnants, which can be a potential metastatic pathway, as well as the braided lymphatic network drainage. Hence, primary malignant neoplasms affecting the umbilicus require a different and more radical surgical approach compared with other melanomas.

Case presentation: In this report, we describe a series of three patients of Caucasian ethnicity who presented with primary umbilical melanoma at the National Cancer Institute of Naples, Italy. All patients underwent wide excision of the tumor including the underlying peritoneum. No surgical complications, either immediate or delayed, were observed in any of the patients. Sentinel lymph node biopsy was negative in two cases. Two of the patients developed metastatic disease and died after systemic medical therapy. The other patient is currently in follow-up, and remains disease-free after 21 months.

Conclusions: The umbilicus has vascular and embryological connections with the underlying peritoneum, so that early visceral involvement is more likely to occur with primary umbilical melanomas. As such, tumor resection including the underlying peritoneum is required to avoid local relapse, whilst sentinel lymph node biopsy appears to be of poor diagnostic value.

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Related in: MedlinePlus

Case 1. (a) Specimen cut in half: Umbilicus cavity is completely filled by tumor (b) poorly differentiated cells, that look primitive, disorganized and immature (hematoxylin and eosin, ×10) (c) diffused anisocytosis, anisonucleosis, altered nuclear-cytoplasmic ratio and evident nucleoli (hematoxylin and eosin, ×60).
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Fig1: Case 1. (a) Specimen cut in half: Umbilicus cavity is completely filled by tumor (b) poorly differentiated cells, that look primitive, disorganized and immature (hematoxylin and eosin, ×10) (c) diffused anisocytosis, anisonucleosis, altered nuclear-cytoplasmic ratio and evident nucleoli (hematoxylin and eosin, ×60).

Mentions: A 33-year-old Caucasian female presented with a coarse nodular pinkish-brown swelling that covered the natural umbilical cavity. Diagnosis of a nodular melanoma was based on clinical findings, with histological investigation showing a Breslow thickness of 40 mm, ulceration, mitotic rate of 6/mm2 and no tumor-infiltrating lymphocytes (Figure 1). Whole-body fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) was negative for distant disease. The patient underwent pre-operative Tc99 lymphoscintigraphy according to standard procedure and subsequent removal of the umbilical region, which consisted of the tumor with 2 cm margins including the underlying peritoneum. Sentinel lymph node biopsy (SLNB) in the left inguinal and bilateral axillary regions, as indicated by lymphoscintigraphy, were negative for metastases. Six months after surgery, there was local recurrence involving the posterior aspect of the left rectus muscle up to the peritoneum. The patient underwent surgical removal of both rectus muscles including the local recurrence (Figure 2), with the abdominal wall being reconstructed with non-absorbable Marlex mesh.Figure 1


Clinicopathologic features and surgical management of primary umbilical melanoma: a case series.

Di Monta G, Caracò C, Marone U, Grimaldi AM, Anniciello AM, Di Marzo M, Simeone E, Mori S - BMC Res Notes (2015)

Case 1. (a) Specimen cut in half: Umbilicus cavity is completely filled by tumor (b) poorly differentiated cells, that look primitive, disorganized and immature (hematoxylin and eosin, ×10) (c) diffused anisocytosis, anisonucleosis, altered nuclear-cytoplasmic ratio and evident nucleoli (hematoxylin and eosin, ×60).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4404075&req=5

Fig1: Case 1. (a) Specimen cut in half: Umbilicus cavity is completely filled by tumor (b) poorly differentiated cells, that look primitive, disorganized and immature (hematoxylin and eosin, ×10) (c) diffused anisocytosis, anisonucleosis, altered nuclear-cytoplasmic ratio and evident nucleoli (hematoxylin and eosin, ×60).
Mentions: A 33-year-old Caucasian female presented with a coarse nodular pinkish-brown swelling that covered the natural umbilical cavity. Diagnosis of a nodular melanoma was based on clinical findings, with histological investigation showing a Breslow thickness of 40 mm, ulceration, mitotic rate of 6/mm2 and no tumor-infiltrating lymphocytes (Figure 1). Whole-body fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) was negative for distant disease. The patient underwent pre-operative Tc99 lymphoscintigraphy according to standard procedure and subsequent removal of the umbilical region, which consisted of the tumor with 2 cm margins including the underlying peritoneum. Sentinel lymph node biopsy (SLNB) in the left inguinal and bilateral axillary regions, as indicated by lymphoscintigraphy, were negative for metastases. Six months after surgery, there was local recurrence involving the posterior aspect of the left rectus muscle up to the peritoneum. The patient underwent surgical removal of both rectus muscles including the local recurrence (Figure 2), with the abdominal wall being reconstructed with non-absorbable Marlex mesh.Figure 1

Bottom Line: Sentinel lymph node biopsy was negative in two cases.Two of the patients developed metastatic disease and died after systemic medical therapy.The other patient is currently in follow-up, and remains disease-free after 21 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy. gidimonta@libero.it.

ABSTRACT

Background: Primary umbilical melanoma is an uncommon tumor that is poorly described in the medical literature. The umbilical region is a particular anatomic site owing to the presence of embryonal remnants, which can be a potential metastatic pathway, as well as the braided lymphatic network drainage. Hence, primary malignant neoplasms affecting the umbilicus require a different and more radical surgical approach compared with other melanomas.

Case presentation: In this report, we describe a series of three patients of Caucasian ethnicity who presented with primary umbilical melanoma at the National Cancer Institute of Naples, Italy. All patients underwent wide excision of the tumor including the underlying peritoneum. No surgical complications, either immediate or delayed, were observed in any of the patients. Sentinel lymph node biopsy was negative in two cases. Two of the patients developed metastatic disease and died after systemic medical therapy. The other patient is currently in follow-up, and remains disease-free after 21 months.

Conclusions: The umbilicus has vascular and embryological connections with the underlying peritoneum, so that early visceral involvement is more likely to occur with primary umbilical melanomas. As such, tumor resection including the underlying peritoneum is required to avoid local relapse, whilst sentinel lymph node biopsy appears to be of poor diagnostic value.

Show MeSH
Related in: MedlinePlus