Abstract

Synchronous primary cutaneous melanomas, defined as at least two primary melanomas diagnosed within a three-month period, comprises only 2-3% of melanomas. We report a case of a 62-year-old Hispanic male who presented with a two-month history of multiple hyperpigmented skin nodules and patches on his right plantar foot, one of which was ulcerated. Two separate biopsy specimens from the ulcerated nodule on his right medial foot and a nodule on his right heel initially showed invasive melanoma with a Breslow depth of at least 0.8 mm and melanoma in situ, respectively. A subsequent wide excision encompassing all the hyperpigmented skin lesions revealed at least two primary cutaneous melanomas: a deeply invasive melanoma composed of markedly pleomorphic epithelioid and sarcomatoid cells with a Breslow depth of 2.1 mm and an invasive melanoma with a Breslow depth of 0.9 mm. Both melanomas had an in-situ component and the intervening sections lacked evidence of continuous melanoma or regression. Further examination of the entire specimen revealed an area of melanoma in-situ clinically correlating with a separate skin nodule. The intervening sections lacked continuous melanoma as well as melanocytes suggesting possible complete regression. The sentinel lymph nodes were negative for metastatic melanoma. Based on these findings, we diagnosed this patient with at least two synchronous primary cutaneous acral melanomas. Recognition of this rare entity is necessary to ensure accurate diagnosis and staging, and it emphasizes the importance of full physical examination and complete tissue analysis when this is clinically suspected.

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