Fosko Nicole K, Davis Catherine H, Koshenkov Vadim P, Kowzun Maria J
Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick 08901, NJ, USA.
Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick 08901, NJ, USA.
Int J Surg Case Rep. 2021 Jul;84:106155. doi: 10.1016/j.ijscr.2021.106155. Epub 2021 Jun 29.
A patient presented with ipsilateral, synchronous primary malignancies of left upper back melanoma and left breast invasive ductal carcinoma. This complex presentation was managed with a multidisciplinary approach.
A 61-year-old female presented with multiple cutaneous lesions, revealed to be several foci of melanoma in situ as well as a T4b melanoma of the left upper back. On staging work up, a left breast malignancy was incidentally discovered. Genetic testing did not delineate a relevant mutation to explain the synchronous malignancies. Multidisciplinary surgical planning entailed consideration of the lymphatic drainage patterns of the lesions, with both the upper back melanoma and breast carcinoma expected to drain to the left axilla. Ultimately, simultaneous resections of both malignancies were performed as well as concomitant left sentinel lymph node biopsies utilizing dual tracer technique.
Currently, cases of synchronous primary cutaneous melanoma and independent, ipsilateral primary breast carcinoma have not been examined, and thus surgical considerations for axillary staging in this circumstance have not been discussed. The existing literature instead explores the incidence and operative challenges of one malignancy following the other after an interval of time.
This case highlights the utility of a multidisciplinary team for complex oncologic presentations and discusses a creative surgical approach to address two simultaneous primary malignancies involving the left breast and ipsilateral skin of the back. This case emphasizes an exceedingly rare presentation and serves as an important example to educate medical professionals on the innovative and team-based approach to treatment.
一名患者出现左上部背部黑色素瘤和左乳腺浸润性导管癌的同侧同步原发性恶性肿瘤。这种复杂的情况采用多学科方法进行处理。
一名61岁女性出现多处皮肤病变，经检查发现是原位黑色素瘤的几个病灶以及左上部背部的T4b黑色素瘤。在分期检查时，偶然发现左乳腺有恶性肿瘤。基因检测未发现相关突变来解释同步性恶性肿瘤。多学科手术规划需要考虑病变的淋巴引流模式，预计上部背部黑色素瘤和乳腺癌都会引流至左腋窝。最终，同时切除了两种恶性肿瘤，并采用双示踪技术同时进行了左前哨淋巴结活检。
目前，同步原发性皮肤黑色素瘤和独立的同侧原发性乳腺癌病例尚未得到研究，因此在这种情况下腋窝分期的手术考虑也未被讨论。现有文献反而探讨了一种恶性肿瘤在一段时间后发生另一种恶性肿瘤的发生率和手术挑战。
本病例突出了多学科团队在处理复杂肿瘤病例中的作用，并讨论了一种创造性的手术方法来处理涉及左乳腺和同侧背部皮肤的两种同时存在的原发性恶性肿瘤。本病例强调了一种极其罕见的表现，并作为一个重要例子，向医学专业人员传授创新的、基于团队的治疗方法。
