Intravascular and Extravascular Migratory, Metastatic Melanoma of the Great Saphenous Vein

ABSTRACT

Melanoma blood vessel metastases are very uncommon. Wereport this very rare case of metastatic melanoma along thewall of great saphenous vein (GSV), showing intra and extravascular metastasis. By far only a single case of intravascularmetastatic melanoma (IVMM) of GSV and thirty six cases ofextravascular migratory metastatic melanoma (EVMM) ofGSV have been reported. In our case melanoma cells wereseen both inside and outside of the wall of GSV, and in thedermis. A 60 years old male presented with multiple swellingsupper left thigh since one and a half year. Patient wasoperated. All swellings, along with, part of saphenous vein tillthe knee, and small part of skin were excised under GA.Microscopically, hematoxylin and eosin sections given fromvarious sites showed features of malignant melanoma. Tumorcells were seen in the dermis, and the lumen, as well asoutside the wall of saphenous vein, but not in the epidermis.Only very few melanocytic granules were seen in a singlearea of a section. On Immunohistochemistry –, MarkersHMB45, S100 and Vimentin are strong immunoreactive. CKPAN was focal immunoreactive.In our case the melanoma spread along the wall of the GSV.This pericytic angiotropism of melanoma cells, also showingsigns of intravasation, which suggests that melanomacells may migrate along the external surface of vessels, amechanism termed ‘EVMM and also by invading the bloodvessels ‘IVMM’.