Cutaneous melanoma is a malignant neoplasm arising from melanocytes and represents one of the leading causes of mortality from skin cancer due to its high capacity for invasion and metastatic spread. Although its diagnosis is usually based on well-established clinical criteria, such as the ABCDE rule, atypical presentations may occur and can make early recognition difficult, potentially delaying appropriate treatment. We present the case of an adult patient with a pigmented lesion characterized by irregular features and progressive evolution, whose clinical and dermoscopic evaluation raised suspicion for melanoma. Surgical excision of the lesion was performed followed by histopathological analysis, which confirmed the diagnosis of cutaneous melanoma. Microscopic evaluation allowed the determination of tumor thickness and level of invasion, which are essential parameters for staging and prognosis. Management consisted of surgical margin widening according to current oncologic recommendations, with favorable clinical outcomes during follow-up. This case highlights the importance of considering melanoma in the differential diagnosis of pigmented lesions with unusual clinical characteristics and emphasizes the fundamental role of thorough clinical examination, dermoscopy, and histopathological evaluation in establishing an accurate diagnosis. Early detection of melanoma remains a key factor in improving prognosis and reducing mortality associated with this neoplasm.
López-Alvarado et al. (Wed,) studied this question.