Parotid metastasis of an amelanotic melanoma of the scalp: The great masquerader.
BACKGROUND
Cutaneous melanoma is often characterized by its pigmented appearance; however, up to 8.1% of such lesions contain little or no pigmentation. Amelanotic melanomas, lesions devoid of visible pigment, present a diagnostic quandary because they can masquerade as many other skin pathologies. Recognizing amelanotic melanoma is even more clinically challenging when it is first detected as a metastasis to the secondary tissue.


METHODS
We report a rare case of metastasis of an amelanotic melanoma to the parotid gland.


RESULTS
A 75-year-old man presented with an 8-month history of a painless, mobile, hardened mass in the right parotid region. Histopathological analysis of a fine-needle aspiration biopsy of the parotid mass indicated that the mass was melanoma. Careful clinical and radiological examination revealed an 8 mm erythematous papule in the right temporal scalp, initially diagnosed by visual examination as basal cell carcinoma. After right superficial parotidectomy, neck dissection, and excision of the temporal scalp lesion, histological examination revealed the scalp lesion to be amelanotic melanoma.


CONCLUSIONS
Although metastatic amelanotic melanoma to the parotid gland is a rare diagnosis, the clinician should be familiar with this presentation to increase the likelihood of making the correct diagnosis and delivering prompt treatment.
Maxillofacial Surgery Unit of Department of Plastic, Reconstructive, Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Hospital São João, Porto, Portugal.
Tiago
T
Neto
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
Richard
R
Nunes
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
Isabel
I
Amado
Maxillofacial Surgery Unit of Department of Plastic, Reconstructive, Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Hospital São João, Porto, Portugal.
Rui
R
Balhau
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
Hugo
H
Marques
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
David
D
Sanz
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
Margarida
M
Mesquita
Maxillofacial Surgery Unit of Department of Plastic, Reconstructive, Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Hospital São João, Porto, Portugal.
Isabel
I
Pinto
Maxillofacial Surgery Unit of Department of Plastic, Reconstructive, Aesthetic Surgery, Maxillofacial Surgery, and Burn Unit, Hospital São João, Porto, Portugal.
Inês
I
Correia-Sá
Department of Maxillofacial Surgery, Centro Hospitalar Universitário de Coimbra, Portugal.
Artur
A
Ferreira
D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D018328:Melanoma, Amelanotic / Q000556:secondary* / Q000601:surgery; D010307:Parotid Neoplasms / Q000556:secondary* / Q000601:surgery; D012535:Scalp / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery
amelanotic; melanoma; metastasis; parotid