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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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Case 2. (a) Pre-operative view (b) wide excision comprising the underlying peritoneum.
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Fig3: Case 2. (a) Pre-operative view (b) wide excision comprising the underlying peritoneum.

Mentions: A 50-year-old Caucasian female had previously undergone removal of a pigmented lesion of the umbilical region at a hospital other than our institute, with histological findings of superficial spreading melanoma, Breslow thickness 2.5 mm, ulceration, mitotic rate of 6/mm2 and brisk tumor-infiltrating lymphocytes. After referral to our centre, the umbilical region, including the scar from the initial excision of the lesion, with a 2 cm lateral margin including the underlying peritoneum was surgically removed (Figure 3). The reconstruction of the umbilicus was carried out by means of two local transposition flaps transferred towards the linea alba. SLNB in the right inguinal basin was negative for metastases. The patient remains disease-free after 21 months of follow-up.Figure 3


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 2. (a) Pre-operative view (b) wide excision comprising the underlying peritoneum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Case 2. (a) Pre-operative view (b) wide excision comprising the underlying peritoneum.
Mentions: A 50-year-old Caucasian female had previously undergone removal of a pigmented lesion of the umbilical region at a hospital other than our institute, with histological findings of superficial spreading melanoma, Breslow thickness 2.5 mm, ulceration, mitotic rate of 6/mm2 and brisk tumor-infiltrating lymphocytes. After referral to our centre, the umbilical region, including the scar from the initial excision of the lesion, with a 2 cm lateral margin including the underlying peritoneum was surgically removed (Figure 3). The reconstruction of the umbilicus was carried out by means of two local transposition flaps transferred towards the linea alba. SLNB in the right inguinal basin was negative for metastases. The patient remains disease-free after 21 months of follow-up.Figure 3

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