Simultaneous cutaneous melanoma and ipsilateral breast cancer with metastasis to the same axilla. A case report with a focus on a multidisciplinary approach.

INTRODUCTION AND IMPORTANCE: Treatment of simultaneously occurring primary malignancies with separate lymphatic drainage is a surgical and medical challenge. We present a patient in which multidisciplinary management of coexisting melanoma and breast cancer was mandatory for optimal results. CASE PRESENTATION: A 67-year-old female had a primary surgical resection for a skin lesion on the back. Histology revealed melanoma with a Breslow thickness of 4.8 mm. According to guidelines, a wide local excision was scheduled. Prior to the surgery, routine mammography revealed simultaneous ipsilateral breast cancer. A preoperative work-up revealed a pathological lymph node in the left axilla. Biopsies found metastasis from malignant melanoma. She had combined surgery with breast-conserving therapy, wide local excision of the skin on the back, and extended axillary clearance of levels I-III. Final histology revealed axillary metastases both from melanoma and breast cancer. Adjuvant therapy was decided based on a multidisciplinary approach. CLINICAL DISCUSSION: To our knowledge, cases of synchronous primary cutaneous melanoma with biopsy-verified axillary metastases and independent, ipsilateral primary breast carcinoma have not been described. The surgical approach was done according to guidelines. The breast cancer was re-staged based on the histology of the surgical specimen. Adjuvant treatment was a combination of treatment strategies for the two primary malignancies. CONCLUSION: This case highlights the need for a multidisciplinary approach in treating simultaneous breast cancer and melanoma both with axillary metastasis. The optimal treatment approach was based on close collaboration between surgeons, oncologists, radiologists, and pathologists. Multidisciplinary meetings are mandatory for optimal results.

Renal involvement in paediatric systemic vasculitis. / Nyreaffeksjon ved systemisk vaskulitt hos barn.

BACKGROUND: Primary systemic vasculitis is a rare condition in children, which often has a slowly progressive course with diffuse symptoms and is therefore easily overlooked. Early initiation of treatment can prevent severe kidney disease. The aim of this study was to survey the extent of renal involvement in children with systemic vasculitis at Oslo University Hospital, Rikshospitalet. MATERIAL AND METHOD: This observational retrospective study was based on a review of medical records, laboratory results and renal biopsies from first admission to last check-up at Oslo University Hospital, Rikshospitalet, for the period 2000­14. RESULTS: A total of 66 children (35 boys) under 18 years of age were treated at the hospital for primary systemic vasculitis in the period in question. Objective signs of renal involvement were found in 39 (59 %) at the first consultation and in 42 (64 %) over the course of the disease. Twenty-nine patients (44 %) underwent renal biopsy. Of the 41 patients with proven renal involvement that were still alive at the time of the last check-up, 12 continued to require treatment for renal impairment. Three patients had undergone renal transplantation, 18 were in remission on immunosuppressive or antihypertensive treatment, while 11 patients had achieved medication-free renal remission. INTERPRETATION: There is a high prevalence of renal involvement in paediatric patients treated for systemic vasculitis at Oslo University Hospital, Rikshospitalet. At their final check-up, the majority of patients continue to require treatment and follow-up for kidney disease.