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ACRAL LENTIGINOUS MELANOMA: CASE REPORT
Apresentação do caso
A 51-year-old male patient, born and resident in Chapecó (SC), arrived at the oncology clinic due to a lesion in the left hallux that appeared about 5 years ago and changed the pattern 3 months ago. On physical examination, patient of Asian ethnicity, skin phototype II, with the hyperchromic lesion, with irregular borders, measuring approximately 2.2 x 2.6 cm in the nail bed of the left hallux. The patient reports that, due to her occupation, she wore closed and tight shoes and noticed worsening of the lesion and spontaneous nail detachment for 6 months, associating this with the use of closed shoes. Based on the physical examination, an incisional biopsy of the lesion was performed, and acral lentiginous melanoma (ALM) was diagnosed, with Breslow of 9.7 mm, Clark V, and showed a high mitotic rate (30 mitoses mm(-2)), configuring the locally advanced character of the lesion. Subsequently, the limb was amputated at the level of the metacarpophalangeal joint, and ALM was confirmed. Sentinel lymph node metastasis, as well as bone and lung metastases, were observed in the complementary exams. Patient undergoing routine radiotherapy and chemotherapy, evolving to death about 8 months after diagnosis of the disease.
The estimated incidence of cutaneous melanoma in Brazil in 2020 is around 8,450, and ALM usually corresponds to less than 5% of these. Despite being one of the least common subtypes, ALM is considered one of the most aggressive, mainly due to its invasiveness, dissemination to the regional lymph node chain, and distant metastases, often linked to late diagnosis of the disease. It is characterized by affecting mainly Afro-descendants, being less common among Caucasians. In the present case, the development of advanced disease was observed in a patient of Asian ethnicity, which is cited in studies as one of the most susceptible to this subtype. The prognosis is usually reserved even with aggressive treatment, due to the advanced stage in which the disease is usually found.
In malignant skin neoplasms, especially melanoma, early diagnosis is essential for a favorable evolution of the disease. In the case of ALM, as it is known to be aggressive, it is essential to inform the population and medical colleagues about the identification of the initial disease, as well as the dissemination of correct information to patients with suspicious lesions, so that they can reach a service of reference as soon as possible.
Melanoma; Skin Neoplasms;
DOMINIQUE VALENTINA TEREBINTO, RAFAEL VICTOR MIERZWA, LUCIANO DOTTA GUARIENTTI