Amelanotic malignant melanoma: two collision tumors presenting as basal cell carcinoma and atypical fibroxanthoma

Ann Clin Lab Sci. 2008 Spring;38(2):157-62.

Abstract

Collision (contiguous) tumors of the skin can result in misleading clinicopathological presentations, and the choice of appropriate diagnostic techniques may prevent incomplete diagnosis and management. We report 2 cases of collision tumors involving amelanotic malignant melanoma of the back. One patient is a 79-yr-old male with an 8.7 x 5.5 x 4.5 cm polypoid lesion that on shave biopsy was diagnosed as basal cell carcinoma. Subsequent excision showed that the lesion was largely composed of amelanotic melanoma underlying a relatively small and thin basal cell carcinoma, and this probably would have been demonstrated in a punch (rather than shave) biopsy. The other patient is a 71-yr-old male with a 1 cm exophytic lesion on the back, which was determined microscopically to be melanoma, and a 0.6 cm papule on the back. This lesion was composed of 2 distinct contiguous neoplastic infiltrates, the predominant component being an atypical fibroxanthoma and the smaller component an amelanotic melanoma (primary vs metastatic), with diagnostic confirmation requiring multiple immunohistochemical stains.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antigens, Neoplasm / metabolism
  • Biomarkers, Tumor / metabolism
  • Carcinoma, Basal Cell / diagnosis*
  • Carcinoma, Basal Cell / metabolism
  • Carcinoma, Basal Cell / pathology
  • Diagnosis, Differential
  • Histiocytoma, Benign Fibrous / diagnosis*
  • Histiocytoma, Benign Fibrous / metabolism
  • Histiocytoma, Benign Fibrous / pathology
  • Humans
  • Immunohistochemistry
  • Male
  • Melanoma, Amelanotic / diagnosis*
  • Melanoma, Amelanotic / metabolism
  • Melanoma, Amelanotic / pathology
  • Neoplasms, Multiple Primary / diagnosis*
  • Neoplasms, Multiple Primary / metabolism
  • Neoplasms, Multiple Primary / pathology
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / metabolism
  • Skin Neoplasms / pathology

Substances

  • Antigens, Neoplasm
  • Biomarkers, Tumor