The recurrence of melanoma in patients is well-documented, and is dependent on a number of factors. We report a case in which a patient had a case of ganglionar metastasis in the neck after a 30-year disease-free interval following primary treatment.11421131113

Lage H.T.

Martins A.S.

Souza L.S.

Tincani A.J.

Repositorio da Producao Cientifica e Intelectual da Unicamp

Alfio Jose Tincani, Antonio Santos Martins,
Henriette de Toledo Lage, Lincoln Santos Souza
Melanoma Ganglionic Metastasis 30 years after treatment of
the primary tumor - A case report
Head and Neck Surgery Services of the Department of Surgery at the Schoolfor Medical Science at the
State University of Campinas (UN/CAMP) - Camp inas, Brazil
The recurrence of melanoma in patients is well-documented, and is dependent on a number of factors. We report a case in which a
patient had a case of ganglionar metastasis in the neck after a 30-year disease-free interval following primary treatment.
UNITERMS: Late metastasis of cutaneous melanoma. Cutaneous melanoma. Head and neck melanoma.
INTRODUCTION
The recurrence of melanoma is a well-documentedclinical fact in the medicalliterature.3 At the Headand Neck Surgery Services of the Department of
Surgery at UNICAMP, we had a case in which a patient
showed cervical lymphatic metastasis 30 years after being
diagnosed and treated for a primary lesion situated on the
skin in the suprascapular region.
CASE REPORT
In 1963, M.R.V., an 18-year old woman, displayed a
dark nodular lesion 1.0 cm in diameter on the skin in the
Address for correspondence:
Alfio Jose Tincani
Rua Luverci Pereira de Souza, 1765
Campinas/SP - Brasil - CEP 13084-031
right suprascapular region. She was treated at another
clinic. An ample resection of the lesion was performed
and an anatomopathological histological test revealed it
to be a Clark III and Breslow 1.2 mm melanoma. The
patient was followed for six conse.cutive years without
evidence of local recurrence or metastasis.
In 1993, at the age of 48, the patient contacted us on
account of the appearance of a hardened nodule in the
right supraclavicular fossae. The tumor appeared in the
area of drainage of the previous nodule.
Laboratory exams and imaging were completed not
only to determine the patient's stage, but also to exclude a
second primary tumor. The diagnosis of metastasis of the
melanoma was confirmed by an aspirate of the cervical
ganglion with a fine needle. In May of 1993; a cervical
ganglionic removal of the upper, mid, and lower jugular
carotid chain was performed on the patient, as well as on
the supraclavicular fossae on the right side (levels II, III,
IV and V). The final histological examination revealed
metastasis melanoma with extracapsular invasion in I
cervical lymph node among 21 examined. The patient has
been in ambulatory follow-up for 15 months without
evidence of disease.
TINCANI, A.J.; MARTINS, A.S.; LAGE, H.T. & SOUZA, L.S. - Melanoma ganglionic metastasis
30 years after treatment of the primary tumor - A case report
Sao Paulo Medical Journal/RPM 114(2): 1131-1133, 1996
1132
DISCUSSION
The majority of recurrences and deaths from
cutaneous melanoma occur within the first 10 years of
diagnosis and treatment of the primary lesion, and are
common after this period.3.6
In the medical literature,? there has only been one
description of late recurrence with a disease-free interval
of 30 years, as in the case of our patient. The majority of
recurrences described occurred between 10 and 20 years
later.1.2.3.6.7 The slight possibility of a recurrence after 30
years leads us to consider that this may be the case of a
second primary tumor.2 Most late recurrences involving
lymph nodes occur in the area of the drainage of the
primary tumor. However, SHAW et al.6 describe 47 percent
of their cases of late recurrences in areas distant from the
primary lesion (distant lymph nodes, subcutaneous nodules
or visceral metastasis or in the central nervous system).
A review of the cases described in the literature reveal
common characteristics in the patients with cutaneous
melanoma with late recurrences. The majority of patients
are premenopausal women under the age of 50, which
suggests that natural steroid tumors may affect the natural
history of the patients. I Also, occurrence in the lower limbs
is more common in women, and has a more favorable
prognosis. 1.6
KOH et al.3 describe two cases of recurrences of
melanoma 14 and 18 years after treatment of the primary
tumor. A possible explanation for this phenomenon of late
recurrence could be that a small portion of tumor cells
could have a potential for metastasis, and in individuals
with a subsequent recurrence, these cells could have been
dormant for years before becoming evident.
MASTRANGELO et al.4 believe that there is a
connection to the immune system of the host. There could
be a loss of antingenic manifestation altering the tumor
immunogenicity or of the immune system of the host,
therefore causing the late metastasis.
REINTGAN et al.5 believe that immunological
factors could also cause a second primary metacronic
tum0.r, and this would recede spontaneously leaving only
the metastatic disease. This can be observed in 5 percent
of the cases of metastatic melanoma.
CONCLUSION
The occurrence after an interval of 30 years between
treatment of the primary tumor and the appearance of a
ganglioma metastasis is extremely rare in all malignant
. tumors, especially in the case of cutaneous melanoma.
Only from 1 to 7 percent of the patients treated for
cutaneous melanoma develop a recurrence 10 years after
the initial treatment. Premenopausal women with a
melanoma located in the lower limbs have a greater chance
of late recurrence.
A follow-up of the patient over a long period (more
than 10 years) is essential for identification and early
treatment of recurrences.
RESUMO
A recidiva de melanoma em pacientes previamente tratados e bastante descrito na literatura e esta recidiva depende de varios
fatores. Apresentamos um caso de melanoma cutaneo metastatico para regiao cervical onde a paciente teve um intervalo livre
da doen<;:ade 30 anos entre seu tratamento inicial e 0 aparecimento da metastase ganglionar.
Sao Paulo Medical Journal/RPM 114(2): 1131-1133, 1996 TINCANI, A.J.; MARTINS, A.S.; LAGE, H.T. & SOUZA, L.S. - Melanoma ganglionic metastasis
30 years after treatment of the primary tumor - A case report
1133
REFERENCES
1. Briele HA, Beattie CW, Ronan SG, Chaudhuri PK, Das Gupta
TK. Late recurrence of cutaneous melanoma. Arch Surg
1983; 118:800-3.
2. Callaway MP, Briggs Jc. The incidence of late recurrence
(greater than ten years): An analysis of 536 consecutive cases
of cutaneous melanoma. Br J Plast Surg 1989;42:46-9.
3. Koh HK, Sober AJ, Fitzpatrick TB. Late recurrence (beyond
ten years) of cutaneous malignant melanoma. JAMA
1984;25.J :1859-62.
4. Mastrangelo MJ, Bellet RE, Berd D. Immunology and
Immunotherapy on human cutaneous malignant melanoma.
In: Clark WH, Goladman LI, Matrangleo MJ, eds. Human
Maligant Melanoma. New York:Grune & Stratton Inc.,
1979:355-416.
5. Reintgen DS, McCarty KS, Woodard B. Metastatic malignant
melanoma with unknown primary. Surg Gynecol Obstet
1982; 156:335-40.
6. Shaw HM, Beattie CW, McCarthy WH, Milton GW. Late
relapse from cutaneous Stage I malignant melanoma. Arch
Surg 1985;120:1155-9.
7. Tahery DP, Moy RL. Recurrent Malignant Melanoma
following a 35-year disease-free interval. Int J Derml Surg
Oncol 1993; 19: 161-3.
TINCANI, A.J.; MARTINS, A.S.; LAGE, H.T. & SOUZA, L.S. - Melanoma ganglionic metastasis
30 years after treatment of the primary tumor - A case report
Sao Paulo Medical Journal/RPM 114(2): 1131-1133, 1996


Melanoma Ganglionic Metastasis 30 Years After Treatment Of The Primary Tumor--a Case Report.

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Melanoma Ganglionic Metastasis 30 Years After Treatment Of The Primary Tumor--a Case Report.

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