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September 2009

Primary Scrotal Melanoma Presenting as a Large, Amelanotic, Exophytic Mass

Arch Dermatol. 2009;145(9):1071-1072. doi:10.1001/archdermatol.2009.223

A 62-year-old man presented with a 1-year history of an increasingly painful, progressively enlarging, nonpigmented, exophytic and ulcerative mass on the right side of his scrotum (Figure 1). Histologic examination of the lesion demonstrated a nodular melanoma extending to the base of the specimen (Figure 2). Results of melan-A staining were strongly positive, and those for pan cytokeratin and CD45 were negative. Positron emission tomography–computed tomography showed diffuse skeletal and liver metastases and his TNM stage was T4b N3 M1c. The tumor was treated for palliation with wide local excision, and the results of subsequent analysis of the tumor for a KIT gene mutation were negative. Unfortunately the patient died soon after the resection from malignant hypercalcemia related to the metastatic disease.

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