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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 3. (a) Computed tomography image showing nodular swelling in the umbilical region (b) Computed tomography image of left groin lymphadenopathy of 54 x 28 mm (c) pre-operative view (d) wide excision comprising the underlying peritoneum.
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Fig4: Case 3. (a) Computed tomography image showing nodular swelling in the umbilical region (b) Computed tomography image of left groin lymphadenopathy of 54 x 28 mm (c) pre-operative view (d) wide excision comprising the underlying peritoneum.

Mentions: A 77-year-old Caucasian male had previously undergone removal of a pigmented lesion in the umbilical region at another hospital. Histology showed an ulcerated cutaneous melanoma of 3 mm thickness and mitotic rate of 6/mm2. No further treatment was administered until, twelve months later, the patient presented with a swelling underlying his umbilicus. Clinical and instrumental examinations showed a coarse nodular swelling in the umbilical region, most likely local disease recurrence, and major lymphadenopathy of 54 × 28 mm in the left groin, which was positive in pre-operative cytology. The patient underwent left superficial and deep groin dissection and omphalectomy, with 2 cm of lateral margin extended up to the underlying peritoneum (Figure 4). The patient then underwent medical treatment of subsequent bone and liver metastases but died eight months later due to disseminated disease.Figure 4


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 3. (a) Computed tomography image showing nodular swelling in the umbilical region (b) Computed tomography image of left groin lymphadenopathy of 54 x 28 mm (c) pre-operative view (d) 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

Fig4: Case 3. (a) Computed tomography image showing nodular swelling in the umbilical region (b) Computed tomography image of left groin lymphadenopathy of 54 x 28 mm (c) pre-operative view (d) wide excision comprising the underlying peritoneum.
Mentions: A 77-year-old Caucasian male had previously undergone removal of a pigmented lesion in the umbilical region at another hospital. Histology showed an ulcerated cutaneous melanoma of 3 mm thickness and mitotic rate of 6/mm2. No further treatment was administered until, twelve months later, the patient presented with a swelling underlying his umbilicus. Clinical and instrumental examinations showed a coarse nodular swelling in the umbilical region, most likely local disease recurrence, and major lymphadenopathy of 54 × 28 mm in the left groin, which was positive in pre-operative cytology. The patient underwent left superficial and deep groin dissection and omphalectomy, with 2 cm of lateral margin extended up to the underlying peritoneum (Figure 4). The patient then underwent medical treatment of subsequent bone and liver metastases but died eight months later due to disseminated disease.Figure 4

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