Skill Checkup: A 73-Year-Old Woman With Resected Melanoma in the Cervical Spine

Jonathan S. Zager, MD


April 06, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 73-year-old woman presented for follow-up of malignant melanoma. The melanoma was resected in the cervical spine; it was ulcerated with a Breslow depth of 3 mm.

Wide local excision (WLE) was performed with 2-cm margins as well as a sentinel node biopsy (SLNB). The WLE was negative in terms of margins, and no residual melanoma was seen in the specimen; in addition, the SLNB was negative.

Then, 5.5 years later, the patient presented to her primary care physician complaining of some fatigue for the past month with some vague right-sided abdominal pain. Assessment was performed with ultrasound of the abdomen, which showed a suspicious 5-cm mass in the left lobe of the liver. MRI was ordered, which confirmed the findings of a solitary left hepatic nodule of approximately 5.5 cm. Full-body PET did not reveal any other evidence of disease, and brain MRI was negative. The primary care physician sent the patient back to the surgical oncologist for management of this new left hepatic lobe mass.

The patient was discussed at a multidisciplinary conference after a fine-needle aspiration was performed of the mass, confirming that it was metastatic melanoma. The consensus was that because there was a long disease-free interval and the patient was deemed resectable with a solitary lesion in the left hepatic lobe, the patient would undergo resection of the mass followed by adjuvant therapy. The patient was taken to the operating room for a left hepatectomy. Pathology confirmed that the lesion was indeed metastatic melanoma, and negative margins were obtained. The tumor did not harbor a BRAF mutation.


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