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JAMA Surgery Clinical Challenge
January 2017

Rapidly Growing, Bleeding Mass on a Golfer’s Back

Author Affiliations
  • 1Surgical Service, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana
  • 2The Center for Innovations in Quality, Outcomes, and Patient Safety, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana
  • 3Department of Surgery, Louisiana State University–Shreveport
JAMA Surg. 2017;152(1):101-102. doi:10.1001/jamasurg.2016.3982

A previously healthy, fair-skinned professional golfer aged 69 years with a history of frequent outdoor sun exposure presented to the surgery clinic with a mass on his left upper back, which he first noted 1 year ago as a small nodule on his back. It grew rapidly throughout the past year, becoming increasingly painful and bleeding easily with light contact.

Clinical examination revealed an 8 × 6 × 4-cm multilobulated, purplish lesion that was fungating and friable (Figure 1). He also had a palpable, hard mass in the left axilla. He had no other lesions elsewhere on his body. A punch biopsy of the back mass revealed immunohistochemistry strongly positive for S-100, MART-1, and HMB-45. Computed tomographic and positron emission tomographic scans demonstrated a fludeoxyglucose-avid lesion on the back extending into the subcutaneous fat and fludeoxyglucose-avid uptake in the left axilla.

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