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JAMA Oncology Clinical Challenge
May 23, 2019

Diffuse Hyperpigmentation in a Patient With an Axillary Mass

Author Affiliations
  • 1Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
  • 2Division of Infectious Disease, University of Louisville, Louisville, Kentucky
JAMA Oncol. 2019;5(8):1215-1216. doi:10.1001/jamaoncol.2019.0524

A white man in his early 40s with a medical history of chronic lymphocytic leukemia (Rai stage 0) reported a 6-month history of a growing mass in his right axilla and weight loss. Physical examination revealed palpable right axillary lymphadenopathy. The patient was an active smoker (1 pack per day) with an unremarkable family history. A positron emission tomography scan showed a hypermetabolic right axillary lymph node that measured 5 × 5 cm as well as multiple liver lesions, the largest of which measured 8 cm. The results of a core needle biopsy specimen from the right axillary lymph node were consistent with malignant neoplasm, with immunohistochemistry staining positive for S100, HMB-45, and MART-1. He began pembrolizumab therapy.

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