A rare case involving a 93-year-old woman highlights how nipple melanoma can be mistaken for another cancer, potentially leading to more extensive surgery than necessary.
A rare case of nipple melanoma has highlighted the challenges doctors face in diagnosing unusual cancers. The case involved a 93-year-old woman who had a bleeding and ulcerated lesion on her left nipple for eight months. Initially diagnosed as undifferentiated sarcoma, the tumor was later identified as invasive melanoma after surgery.
The case highlights the importance of accurate diagnosis, particularly when unusual tumors resemble other diseases.
Initial Diagnosis Led to Extensive Surgery
The woman had a firm, purple-colored mass measuring around 3–4 cm. Breast imaging revealed a suspicious mass measuring 44 × 35 mm, along with enlarged lymph nodes in the armpit. However, a fine-needle aspiration test did not detect cancer cells.
A core biopsy initially suggested undifferentiated sarcoma, prompting doctors to perform a modified radical mastectomy and remove the axillary lymph nodes.Further examination of the removed tissue revealed that the tumor was actually an invasive superficial spreading melanoma, a type of skin cancer.
Additional Tests Helped Confirm Melanoma
Doctors used immunohistochemistry, a laboratory technique that identifies specific proteins in tumor cells, to confirm the diagnosis. Additional testing detected several melanocytic markers, including S100, Elan-a and HMB45.
The tumor was at least 60 mm thick, with a high rate of cell division. However, all 15 removed lymph nodes were free of cancer, and the surgical margins were clear.
The case was classified as Stage IIC melanoma, with no evidence of distant spread.
Following a multidisciplinary review, doctors decided against additional treatment, mainly because of the patient’s advanced age. At 26 months after diagnosis, she remained free of the disease.
Early Recognition Could Help Avoid Extensive Surgery
Primary melanoma of the nipple-areolar complex is extremely rare. It can resemble Paget disease, breast cancer or benign skin conditions, making diagnosis difficult.
The case also raises questions about the most appropriate treatment. Experts generally favor wide local excision, which removes the tumor and a margin of surrounding tissue, rather than mastectomy when clinically appropriate. Sentinel lymph node biopsy can also help assess whether cancer has spread.
The findings underline the need to consider melanoma in persistent nipple lesions and use appropriate biopsies and comprehensive laboratory testing to guide treatment.
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