Melanomas are malignant tumors of melanocytes that arise from neural crest cells, which are abundantly found in the epidermis and hair follicles.1 It is more common in white populations. Here, we present a 50-year-old female with unusual morphology of nodular malignant melanoma masquerading as a vascular tumor, which was confirmed through histopathological examination. A 50-year-old woman with no known comorbidities presented to our outpatient department with a single, dark, raised lesion over the right gluteal region. Initially, it started as a small lesion, then it rapidly progressed in size over 2 months to attain a size of 2 × 1 cm. The lesion was asymptomatic. There was no known history of similar complaints in the past. There were no similar lesions elsewhere on the body. She had no history of weight loss or loss of appetite. On dermatological examination, a single, pedunculated, polypoidal nodule ranging from grey–white to pinkish in color, measuring 2 × 1 cm, with a few areas of hyperpigmented crust was present over the right gluteal region Figure 1. On palpation, it was a firm, nontender nodule with a smooth, glistening surface, measuring approximately 2 × 1 cm. No lymphadenopathy was noted.Figure 1: Single, pedunculated, polypoidal nodule ranging from grey–white to pinkish in color with few areas of hyperpigmented crusting present over right gluteal region.Routine investigations, such as a complete blood count, random blood sugar levels, renal function test, and urine routine, were performed and found to be within normal limits. A skin excisional biopsy was performed, and the histopathological section showed hyperkeratotic squamous epithelium with focal ulceration. Subepidermis—tumor cells arranged in nests, cords, and singles extending into the dermis Figure 2a. Tumor cells exhibited eosinophilic cytoplasm, large pleomorphic nuclei with clumped chromatin, and prominent eosinophilic nucleoli. Increased mitosis and pigment incontinence Figure 2b were also noted.Figure 2: (a) Subepithelium—tumor cells arranged in nests, cords, and singles extending up to the dermis. Hematoxylin and Eosin (H loss of architecture; and differences in size, shape, and distribution of nests), cytology (nuclear pleomorphism, enlargement and hyperchromatism, prominent nucleoli, and increased mitotic activity), and host inflammatory response (pigmentary change), which were all present in our own histopathology findings. Our case was differentiated from vascular tumors (angiosarcoma, hemangiosarcoma), giant acrochordon, nevus lipomatosus cutaneous superficialis, fibroepithelioma of Pinkus, neurofibromatosis, and collagenoma by histopathological features.[3,4 Therapeutic approaches include surgical resection, chemotherapy, radiotherapy, targeted therapy, and photodynamic therapy.2 We report this case for its rarity and uniqueness, as our case stands out from other few reported cases of pigmented nodular melanoma by being single, large, multilobulated, pigmented, and pedunculated, resembling a vascular tumor. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Prasanna et al. (Thu,) studied this question.