Spindle-cell malignant melanoma

Jaime Company-Quiroga¹ , Héctor Magro-García² , Cristina Martínez-Morán¹

¹ Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
² Department of Internal Medicine, Fundación Instituto San José, Subacute Unity, Madrid, Spain

Correspondence Address:
Jaime Company-Quiroga
C/Camino del Molino, No 2, Fuenlabrada 28942, Madrid
Spain

A 90-year-old woman presented with a long-standing cutaneous lesion localized to the left cheek, which was diagnosed elsewhere as an invasive, spindle-cell malignant melanoma 2 years back. The patient and family had then refused surgical management. When she presented to us, the lesion, first described as a 1–2 cm pigmented nodule, had turned into an exophytic, black-greyish ulcerated tumor [Figure - 1]. The dramatic clinical evolution motivated the consultation and we performed a skin biopsy, confirming the initial diagnosis. Spindle-cell malignant melanoma is a rare morphologic variant of melanoma, characterized by spindle-shaped cells that usually lose immunoexpression of conventional melanoma markers, forming cohesive fascicles along with epithelioid tumor cells. Misdiagnosis is common since cytological and immunohistochemical features are often indistinguishable from other sarcomatous neoplasms (malignant fibrohistiocytoma, fibrosarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor). Palliative care was decided in consultation with the patient and the family, however the patient died 3 days after this photograph.

Figure 1: Pigmented ulcerated tumor on the left cheek

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.