A Case of Late Delayed Metastasis of Malignant Melanoma After 27 Years After First Excision

We report a case of an ultra-late delayed metastasis of malignant melanoma 27 years after the excision of the first tumor. The patient is a 67 years old Italian woman. She underwent a primary excision of a skin lesion of 1cm in diameter on the lower third of the left leg in 1984 when she was 39. According to the histological examination the lesion was a lentigo malign melanoma with an epithelial histological pattern with intra- and subepidermal diffusion. The lesion was 2.2 mm in thickness (Breslow) and was a Clark level IV melanoma; mitotic rate was 6 mitosis/mm2. No melanocytic lesions were found on excision edges and no lymph nodes were removed and examined. In March 2011, when the woman was 67 years old, an inguinal lymph node and an intraabdominal lesion were considered suspect for neoplastic process during a clinical exam of the GP. A histological examination and an eco-imaging procedure described the lesions as metastasis of malignant melanoma probably related to the first skin tumor. Within a few days she was treated with the excision of the abdominal lesion, the total greater omentectomy and the lymphadenectomy of the left inguinal region. Histological examination confirmed the suspect of metastasis of the first melanoma with a predominant epithelioid growing pattern. This case underlines the need of a long-term follow-up period for patients with melanoma.