Verrucous-Keratotic Malignant Melanoma (VKMM)


  • Nikolay Damianov Medical Institute of Ministry of Interior, (MVR-Sofia), Department of General, Vascular and Abdominal Surgery, General Skobelev 79, 1606 Sofia
  • Michael Tronnier Department of Dermatology, Venereology and Allergology, Helios Klinikum GMBH Hildsheim Senator-Braun-Allee 33 – 31135 Hildesheim
  • Nely Koleva Department of Pathology, Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia
  • Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden
  • Serena Gianfaldoni University G. Marconi of Rome, Rome
  • Torello Lotti University of Rome “ G. Marconi”, Rome
  • Jacopo Lotti Department of Nuclear, Subnuclear and Radiation Physics, University of Rome "G. Marconi", Rome
  • Katlein França Institute for Bioethics & Health Policy; Department of Dermatology & Cutaneous Surgery; Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine - Miami, FL
  • Atanas Batashki Abdominal and Thoracic Surgery, Department of Special Surgery, Medical University of Plovdiv, bul. "Peshtersko shose" Nr 66, 4000 Plovdiv
  • Hristo Mangarov Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia
  • Georgi Tchernev Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria; Onkoderma”- Policlinic for Dermatology, Venereology and Dermatologic Surgery, 26 General Skobelev blvd., Sofia



keratotic melanoma, verrucous melanoma, surgical approach, surgical safety, benign like lesions


We 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.


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How to Cite

Damianov N, Tronnier M, Koleva N, Wollina U, Gianfaldoni S, Lotti T, Lotti J, França K, Batashki A, Mangarov H, Tchernev G. Verrucous-Keratotic Malignant Melanoma (VKMM). Open Access Maced J Med Sci [Internet]. 2017 Jul. 24 [cited 2023 Feb. 4];5(4):547-8. Available from:

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