A Rare Differential for Metastatic Melanoma

This case describes a 50 year old man with no previous history of melanoma or non-melanoma skin cancer, who was referred with a suspected diagnosis of metastatic amelanotic melanoma with an unknown primary. Prior to referral he had no skin biopsy, no pathologic diagnosis of primary or metastatic melanoma and an FNA inconclusive for melanoma. He had a 10 week history of an ulcerated lesion on his forearm with ipsilateral epitrochlear and axillary lymph nodes suspicious both clinically and on CT scan. He was referred from a major University hospital after having been seen by both a Plastic surgeon and Dermatologist. This case is important as this diagnosis was assumed in the absence of definitive tissue diagnosis due to an inconclusive FNA. The patient was significantly distressed with the assumed diagnosis of melanoma with nodal metastases implicating the need for significant surgery as well as a significantly reduced life expectancy.