Life's middle finger: malignant melanoma. [Musculoskeletal] [XR] [CT] [CTA]
Life's middle finger: malignant melanoma. [Musculoskeletal] [XR] [CT] [CTA]
54 year old female with a history of minor injury to the finger 6 months before these studies were obtained, subsequently developed an infection requiring debridement. The wound was then stable until 2 months before, when a large, fungating, hemorrhagic mass grew.
X-ray shows large radiopaque mass eroding the distal finger (distal phalanx and distal portion of the middle phalanx).
CT 3D surface reconstructions show the morphology of the mass.
CTA 3D reconstruction shows the mass is very hypervascular.
Lymph node scintigraphy was performed showing a sentinel node at the axilla (not shown). The patient underwent amputation of the finger with axillary sentinel node biopsy, which was positive for metastatic melanoma. The patient was then lost to follow-up.
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Seems kinda weird for a melanoma to develop so acutely following traumatic event no? Maybe it was pre-existing and this injury actually may save their life?
It's a pretty common story with skin cancers actually. Probably was already there microscopically, and the trauma and subsequent infection and surgery made it grow and reveal itself as a wound/ulcer that just won't heal.
As for whether or not the trauma saved her life: sometimes these events do make patients come in, potentially at a point when the cancer is smaller and easier to treat. However, she let the mass grow for weeks and enough time for it to metastasize, and metastatic melanoma has a terrible prognosis (although improving with recent treatments). Although I didn't save anything in my notes, I suspect there was some barrier to care, whether psychiatric or socioeconomic.
Interesting! Always nice to learn new things!
And yeah, melanoma is no joke but the checkpoint inhibitors have made amazing progress. I now see patients years out with no evidence of recurrence even when they presented with positive nodes or even mets.