Verrucous-Keratotic Malignant Melanoma (VKMM)
Keywords:keratotic melanoma, verrucous melanoma, surgical approach, surgical safety, benign like lesions
AbstractWe report a patient with a verrucous keratotic variant of melanoma visiting the policlinic of Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology and Dermatologic surgery, with a keratotic verrucous lesion, located on the right thigh, partially deeply pigmented at upper right quadrant. The lesion had appeared three years ago before her presentation in the policlinic, and it had gradually enlarged and become darker in the last twelve months. The surface of the lesion was covered with thick hyperkeratotic lobules. The histologic evaluation revealed verrucous melanoma with a tumour thickness of 3 mm and Clark Level IV and focal ulceration. The tumour was staged as stage IIB (T3bN0M0). Sentinel lymph node biopsy was planned. Verrucous-keratotic forms of malignant melanoma occur more commonly in women and favour the extremities, but may be found on any anatomic site. Seventy-one percent of this melanoma type are situated on the upper and lower extremities. Although two-thirds of these neoplasms can be can be histologically graded according to the classification of Clark, one-third of these melanomas with marked verrucous hyperplasia and hyperkeratosis of the epidermis do not fit into his classification. Histological classification of patients with a verrucous keratotic type of melanoma may sometimes be extremely difficult. The marked papilliferous architecture of these lesions made an assessment of Breslow depth difficult. The presented case highlights the clinical existence and features of such benign-looking melanomas. It is therefore important for surgical pathologists to recognise this unusual variant of malignant melanoma, as it may be confused both clinically and pathologically with benign lesions.
Plum Analytics Artifact Widget Block
Matsumoto T, Yokota K, Sawada M, Hasegawa Y, Takeuchi A, Kono M, Akiyama M. Large epidermal cleft formation in verrucous-keratotic malignant melanoma of the heel. J Am Acad Dermatol. 2015;72(1):e37-8. https://doi.org/10.1016/j.jaad.2014.09.044 PMid:25497951
Clark WH Jr. A classification of malignant melanoma in man correlated with histogenesis and biologic behaviour. In: Montagna W, ed. Advances in Biology of the Skin, The Pigmentary System, New York: Pergamon Press; 1967: p. 621-47.
Kuehnl-Petzoldt C, Berger H, Wiebelt H. Verrucous-keratotic variations of malignant melanoma: a clinicopathological study. Am J Dermatopathol. 1982;4(5):403-10. PMid:7149193
Suster S, Ronnen M, Bubis JJ. Verrucous pseudonevoid melanoma. J Surg Oncol. 1987;36:134-7. https://doi.org/10.1002/jso.2930360213 PMid:3657177
Requena L, SÃ¡nchez M, Requena C. Simultaneous occurrence of junctional nevus and seborrheic keratosis. Cutis. 1989;44:465-6. PMid:2533059
Blessing K, Evans AT, al-Nafussi A. Verrucous naevoid and keratotic malignant melanoma: a clinico-pathological study of 20 cases. Histopathology. 1993;23(5):453-8. https://doi.org/10.1111/j.1365-2559.1993.tb00494.x PMid:8314219
How to Cite
All rights reserved.