Metastatic malignant melanoma and dermatomyositis: A paraneoplastic phenomenon.

Malignant melanoma has previously been reported with paraneoplastic syndromes including dermatomyositis. We report a case involving a 34-year-old woman who presented with a persistent skin rash over her neck and upper body, with clinical features suggestive of dermatomyositis. The patient had a history of a right shoulder lesion that was previously removed; a solitary axillary lymph node was detected on additional imaging and biopsy results were consistent with malignant melanoma. The following year, surveillance positron emission tomography scan detected a solitary lung metastasis, leading to a partial lobectomy and confirmation of further spread of the malignant melanoma.

Granulomatous mycosis fungoides with extensive chest wall involvement.

A 40-year-old woman presented with a 5-year history of a mass overlying her right pectoralis major muscle. Histopathology of the lesion revealed a florid granulomatous infiltrate including an atypical lymphocytic component with marked epidermotropism consistent with granulomatous mycosis fungoides. Staging investigations demonstrated the tumour to be localized to the right chest. Consequently, the patient was treated with radiotherapy (50 Gy) to the lesion with good clinical effect. However, she soon developed a clinically palpable lesion on the left chest outside the radiotherapy field. Positron emission tomography scanning demonstrated an extensive left-sided chest wall tumour and also residual tumour on the right. This left-sided lesion failed to respond to systemic chemotherapy. Further radiotherapy (50 Gy) has recently been administered to the left chest lesion; the response is being monitored. While granulomatous inflammation has been previously described in cutaneous T-cell lymphomas, it is rare and is often associated with a delay in the diagnosis and difficulty with clinical staging. The clinical presentation can be extremely variable and consequently, diagnosis rests with histological features, immunohistochemical studies and gene rearrangement analysis.

Successful treatment of in-transit melanoma metastases using topical 2-4 dinitrochlorobenzene.

A 78-year-old woman presented with multiple histologically proven in-transit melanoma metastases involving the lower half of the left leg. Initial therapy with liquid nitrogen cryotherapy had some short-lived success but was not tolerated by the patient. As further lesions began to develop, daily topical application of 2% 2-4 dinitrochlorobenzene to the lesions was commenced. During the first 2 years of therapy a partial response was achieved, with treated lesions regressing while new lesions developed. Eventually a long-term remission of almost 2 years with no clinical evidence of cutaneous melanoma deposits was achieved. This treatment did not prevent metastatic lymph node and ultimately fatal liver involvement. Topical immunotherapy can be a useful adjunct in the treatment of cutaneous melanoma metastases, particularly in those patients who are unable to tolerate other destructive modalities of therapy.