Double cancer of plantar malignant melanoma and vulvar extramammary Paget's disease.
A 75-year-old woman presented with a 2-year history of a pigmented nodular lesion on her left sole and a 9-year history of a red infiltrative plaque on the vulva. The plantar lesion was a 15-mm ulcerated nodule located at the center of a 25-mm atypical pigmentation region; the nodule was clinically suspected to be a malignant melanoma. Histopathological analysis of the vulvar lesion biopsy sample indicated extramammary Paget's disease (EMPD). There was no evidence of metastasis in the computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography scans. We simultaneously performed a wide excision of both lesions and a left inguinal sentinel lymph node biopsy. Melanoma cells were identified in the sentinel lymph nodes, and left radical lymph node dissection was performed after a course of neoadjuvant chemotherapy. All the lymph nodes that were resected during the second operation tested negative for melanomas, and the plantar lesion was diagnosed as a stage IIIB malignant melanoma (pT4b, Na2, M0). Thereafter, we administrated four courses of chemotherapy, and 8 months after the operation, there was no evidence of recurrence or metastatic lesions. We present a case report of double cancer: a plantar malignant melanoma and vulvar EMPD, and also discuss the possible genetic mutations responsible for these two tumors.
Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kamigyo-ku, Kyoto, Japan. takka@koto.kpu-m.ac.jp
Masataka
M
Tsuji
Noriaki
N
Nakai
Eiichiro
E
Ueda
Hideya
H
Takenaka
Norito
N
Katoh
Saburo
S
Kishimoto
D000368:Aged; D005260:Female; D005534:Foot Diseases / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000473:pathology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D010145:Paget Disease, Extramammary / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D014846:Vulvar Neoplasms / Q000473:pathology*