American Society for Peripheral Nerve

Back to 2015 Annual Meeting Program

Neurotropic Melanoma. A Case Report of a Neurotropic Melanoma in the Hand with Proximal Extension Throughout the Median and Radial Nerve
Eduardo Pablo Zancolli, MD1; Eric Reggiani2; Yorell Manon Matos, MD1; Jao Lee2; Eric Christophersen2; Sebastian Lazzari, MD2
1Hand Surgery, Kleinert Kutz, Louisville, KY; 2Hand Surgery, Navy Hospital Pedro Mallo, Buenos Aires, Argentina

Introduction: Neurotropic melanoma is an uncommon type of melanoma. It is locally aggressive, however, nodal invasion and metastases are less common than in conventional melanoma. Clinically it can mimic benign lesions or arise in an amelanotic form leading to late diagnoses and a poor prognosis for the patient. Lesions usually arise associated with other types of melanoma. Less commonly a conventional melanoma reoccurs as a neurotropic melanoma. Over half of the neurotropic melanoma lesions are found on the neck and head. Primary compromise of the hand is less common with few reports of neurotropic melanoma involving the median nerve.

Materials & Methods: We present a case of a 57 year old male patient with history of a malignant epithelioid melanoma on the right thumb with right axillary node and capsular invasion. He came to our Hand Center sixteen months after thumb amputation and axillary lymphadenectomy was performed in another facility. He presented with complaints of pain at the amputated stump. In the physical exam two solid painful masses were palpated. Incisional biopsies revealed tumor recurrence as a neurotropic melanoma with compromise of the median nerve and the sensory branch of the radial nerve. According to oncologic staging and a multidisciplinary committee evaluation, palliative surgery was recommended.

Results: Resection of the lesion from the distal tumor proximally was performed through out the median and radial sensory nerves, until at least two cm of nerve free of macroscopic disease were obtained at the proximal forearm. Although resection was performed maintaining the recommended safe macroscopic margins, subsequent histology revealed positive margins. Adjuvant radiation was performed. Postoperatively the patient experienced reduction of pain, and improved hand function. 16 months postoperative the patient is alive. A new painfull solid mass at the level of the elbow aroused as recurrence of the neurotropic tumor. Further palliate surgery needs to be performed in the patient.

Conclusions: Neurotropism in melanoma is associated with deep invasion at the primary site and positive margins after excision due to its peri and intraneural extension. A multidisciplinary approach is indicated in the treatment of this extremely rare disease in the hand. In this patient a palliative treatment, with a stage of free macroscopic disease improved pain and hand function for a limited period of time. Local aggressiveness of this tumor makes it difficult to obtain a durable palliative treatment.

Back to 2015 Annual Meeting Program