Abstract
Black/bluish discolored skin tumor without cuticular covering de novo from site of origin could be a diagnostic feature of melanomas.
Keywords: Diagnostic sign, primary melanoma, absent cutis de novo
Case Report
A 65-year-old male presented with mulberry bossilated black to bluish tinged scrotal mass which was devoid of cuticular coverage de novo from site of origin. It grew painlessly two of 7 cm × 10 cm and abraded at two places which oozed blood on touch and grew painlessly [Figure 1]. This was associated with painless lymphadenopathy in right inguino-femoral and left inguinal region which were of soft consistency and fixed to underlying structures without intervening cuticular nodules.
Figure 1.
Mulberry bossilated black to bluish tinged scrotal mass
Histopathology of biopsied scrotal mass revealed features of malignant melanoma in form of marked cellular atypia, prominent eosinophillic nucleoli with abundant mitotic figures, nuclear grooves with junctional activity, and melanin pigmentation in surrounding tissue [Figure 2].
Figure 2.
Histopathology showing prominent eosinophillic nucleoli with abundant mitotic figures (H and E, ×400)
FNAC from lymphadenopathy yielded inguinal lymphadenopathy yielded thin blackish aspirate. Smear showed malignant cells with macrosomal nucleoli and intracytoplasmic pigmentation. Clinical staging of tumor was T4bN3M0 (AJCC.2002). The scrotal mass was excised and patient was advised for systemic chemotherapy with dacarbazine (DTIC).
Discussion
The case is being reported to highlight the observation that tumor was devoid of cuticular coverage de novo even from its site of origin and could not be described as fungating. The other usual tumors of skin do have skin or cutilcular coverage before they fungate. The reason of absent cuticular coverage in melanoma is from melanin pigment cells located in epidermis itself, so could be a diagnostic hallmark of cuticular melanoma.
Footnotes
Source of Support: Nil
Conflict of Interest: Nil.
