title: Unusual bleeding of a giant cell fibroblastoma: a soft tissue sarcoma of the skin mimicking metastatic melanoma.
abstract: A 56 year-old man presented to the emergency department after a spontaneous bleeding of a giant mass located on the right axilla. Clinical diagnosis was recurrent hemorrhagic nodular melanoma. Ten months previously a malignant melanoma had been removed from the dorsum by radical excision and surgical margins had been disease-free (MM: Breslow IV, Clark IV, lung and lynphnode metastases). The patient required immediate emergency surgical intervention to prevent death by hemorrhagic shock. The tumor was bleeding and the patient required a transfusion. Subjective symptoms included pain in palpation and spontaneous hemorrhage, poor general appearance, pale skin, BP 80/40 mmHg, HR 100/min with overall symptoms of hypovolemic shock. At the time of surgery, radical tumor excision was performed with an approximately 3 cm circumferential gross tumor free margin. The resultant defect was reconstructed by pectoral rotation fascio-cutaneous flap. The histological diagnosis demonstrated an undifferentiated high-grade pleomorphic sarcoma with microscopic tumor free margins.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Castriconi
authors.forename: Massimo
authors.initials: M
authors.lastname: Antropoli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Grillo
authors.forename: Mauro
authors.initials: M
authors.lastname: Andreano
authors.forename: Mariangela
authors.initials: M
authors.lastname: Santoro
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Villamania
mesh_terms: D001365:Axilla; D001803:Blood Transfusion; D018223:Dermatofibrosarcoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D004630:Emergencies; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D019651:Plastic Surgery Procedures; D012771:Shock, Hemorrhagic / Q000209:etiology; D012878:Skin Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012883:Skin Ulcer / Q000209:etiology; D013524:Surgical Flaps