Malignant Melanoma in a Patient withMulti-organ Metastatic Disease

This truncal lesion was revealed when a 47-year-old man disrobed for examination after he had fallen on a sheet of ice and broken a rib. The patient-a truck driver and 30 pack-year cigarette smoker-had been aware of the enlarging lesion for about a year but had not sought medical attention because it was asymptomatic.

Lawrence A. Schiffman, DO, of Hazleton, Pa, diagnosed malignant melanoma. The lesion demonstrates all of the classic characteristics of the “ABCD” criteria used to assess suspicious lesions for malignancy¹:

• Asymmetry.
• Border irregularity.
• Color variegation.
• Diameter greater than 6 mm.

This melanoma is an example of the so-called American Flag sign-the red, white, and blue–colored pigmentation that suggests malignant transformation.

This patient was referred for sentinel lymph node biopsy and wide excision of the lesion. The delay in seeking treatment will ultimately cost the patient his life. This case underscores the need for all medical professionals to follow the dermatologist's motto of “Look and ye shall find.”

REFERENCE:1. Friedman RJ, Rigel DS. The clinical features of malignant melanoma. Dermatol Clin. 1985;3:271-283.