In May 2002, a 50-year-old female with known metastatic malignant melanoma presented to our plastic surgery outpatients clinic with a 5 cm×3 cm bruise to the anterior chest (Fig. 1) , centred under which was a subcutaneous nodule. A previous similar presentation had been attributed to unsuspected trauma.
The bruise and subcutaneous nodule were excised under local anaesthetic and examined histologically, revealing an extravasated pool of red blood cells and a haemorrhagic deposit of malignant melanoma, respectively. Her coagulation screen was normal and her medication was non-contributory.
Her primary tumour was a malignant melanoma of Breslow depth 5.1 mm, excised from the left cheek in 1998. A left cervical lymphadenectomy was performed in June 1999, and three of the nine biopsied nodes were positive. Her subsequent clinical course has been one of diffuse and rapidly recurring metastatic melanoma, with more than 17 documented positive excisional biopsies of metastatic disease to the cheek, eyelid, neck, breast, arm, thigh, chest wall, buttock and axilla. She has recently received radiotherapy for bony foot metastases. Her history also includes fibromyalgia and duodenitus.
Unlike haematological malignancies, which are associated with coagulopathy,
1.there are few reports of solid tumours or their metastases presenting with localised bruising. This is surprising given the need for all growing tumours to obtain a blood supply by angiogenesis or local-vessel co-option.
- Falanga A.
- Barbui T.
Coagulopathy of acute promyelocytic leukemia.
Acta Haematol. 2001; 106: 43-51
2.Bruising has been described in parathyroid adenomas,
- Leenders W.P.
- Kusters B.
- de Waal R.M.
Vessel co-option: how tumors obtain blood supply in the absence of sprouting angiogenesis.
Endothelium. 2002; 9: 83-87
- Kihara M.
- Yokomise H.
- Yamauchi A.
- et al.
Spontaneous rupture of a parathyroid adenoma presenting as a massive cervical hemorrhage: report of a case.
Surg Today. 2001; 31: 222-224
- Cliff J.F.
- Newman L.
- Malone M.
- Brady G.
- Cream S.J.
Facial features of widespread neuroblastoma: a case report.
Int J Paediatr Dent. 2001; 11: 215-220
5.but not in association with malignant melanoma.
- Lloyd S.
- Saleh H.A.
- Goh V.
- Ryan R.
A new presentation of angiopathy in neurofibromatosis type 1.
J Laryngol Otol. 2000; 114: 993-994
- Coagulopathy of acute promyelocytic leukemia.Acta Haematol. 2001; 106: 43-51
- Vessel co-option: how tumors obtain blood supply in the absence of sprouting angiogenesis.Endothelium. 2002; 9: 83-87
- Spontaneous rupture of a parathyroid adenoma presenting as a massive cervical hemorrhage: report of a case.Surg Today. 2001; 31: 222-224
- Facial features of widespread neuroblastoma: a case report.Int J Paediatr Dent. 2001; 11: 215-220
- A new presentation of angiopathy in neurofibromatosis type 1.J Laryngol Otol. 2000; 114: 993-994
☆The Publisher apologises for the omission of the first three authors' names in the previously published version of this letter (British Journal of Plastic Surgery 2003; 56: 76).
© 2003 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.