Case report: incidental finding of an ectopic adrenal gland during sentinel lymph node evaluation following melanoma excision

Introduction and importance: Ectopic adrenal tissue is usually found in well-described locations, mainly along the embryological pathway of the adrenal glands. In some cases, fragments of this tissue are found in non-physiological anatomical locations. This discovery, often made by chance, raises questions about these abnormal locations and prompts discussion of etiopathological hypotheses, considering the literature. Case presentation: A 71-year-old man presented with an unclassifiable acral invasive melanoma, according to Clark’s staging system, located in the third interdigital space of the right foot. The patient underwent surgical excision consisting of amputation of the fourth toe with 2 cm margins, followed by the removal of right inguinal sentinel lymph nodes for histological and immunohistochemical evaluation. During this evaluation, ectopic adrenal tissue was identified in the periganglionic fat. Clinical discussion: This case reports the rare discovery of ectopic adrenal tissue during a sentinel lymph node procedure. Although such findings are uncommon, they emphasize the importance of considering embryological migration anomalies in differential diagnoses. Recognizing these benign adrenal rests is crucial to avoid misinterpretation, particularly in oncologic settings such as melanoma. Conclusion: Awareness of ectopic adrenal tissue is essential to prevent diagnostic errors and unnecessary concern about metastasis during oncologic surgical procedures.