Norling Anna Louise, Brøchner Christian Beltoft, Langhans Linnea
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Case Rep Dermatol. 2025 Mar 28;17(1):123-127. doi: 10.1159/000545287. eCollection 2025 Jan-Dec.
Amelanotic melanoma (AM) is a rare subtype of melanoma characterized by the absence of pigmentation, making it difficult to diagnose. This case report describes AM arising in a cicatrix following cardiac surgery, highlighting diagnostic challenges and the importance of reassessment when the clinical findings do not fit the initial diagnosis.
A 76-year-old male underwent coronary artery bypass grafting in March 2022. Nine months later, he noticed a mass with ulceration in the sternal cicatrix. A punch biopsy showed inflammation and fibrosis, leading to a diagnosis of suture granuloma. Despite the lesion's progression over 8 months, no further biopsies or treatments were performed. In September 2023, the patient was referred to the Department of Plastic Surgery at Copenhagen University Hospital, Rigshospitalet, where an excision biopsy revealed an AM with a thickness of 20 mm. Preoperative PET-CT showed no evidence of metastasis, and re-excision with sentinel lymph node biopsy was performed. Adjuvant oncologic treatment was administered due to a positive sentinel node.
This case emphasizes the diagnostic challenges of AM, especially when arising in a cicatrix. When the clinical picture does not align with the initial diagnosis, it is crucial to reconsider and conduct further evaluations to avoid delays in treatment.
无色素性黑色素瘤（AM）是黑色素瘤的一种罕见亚型，其特征是缺乏色素沉着，这使得诊断变得困难。本病例报告描述了心脏手术后瘢痕中出现的AM，强调了诊断挑战以及当临床发现与初始诊断不符时重新评估的重要性。
一名76岁男性于2022年3月接受冠状动脉搭桥手术。九个月后，他在胸骨瘢痕处发现一个伴有溃疡的肿块。一次穿刺活检显示有炎症和纤维化，诊断为缝线肉芽肿。尽管病变在8个月内有所进展，但未进行进一步活检或治疗。2023年9月，该患者被转诊至哥本哈根大学医院里格霍斯皮塔尔的整形外科，在那里进行的切除活检显示为厚度20毫米的AM。术前PET-CT未显示转移迹象，遂进行了前哨淋巴结活检的再次切除。由于前哨淋巴结阳性，给予了辅助肿瘤治疗。
本病例强调了AM的诊断挑战，尤其是在瘢痕中出现时。当临床表现与初始诊断不一致时，重新考虑并进行进一步评估以避免治疗延误至关重要。
