Massive bilateral adrenal metastatic melanoma of occult origin: a case report

Adrenal gland involvement by metastatic melanoma can be found in up to 50% of patients with ocular or cutaneous melanomas. Since these tumors are not hormone secreting, they usually present with locally advanced disease.

We report on the presence of a bilateral massive metastatic adrenal melanoma in an 80-year-old, symptomatic woman with the initial clinical diagnosis of adrenal hemorrhage/carcinoma. Histological assessment of the bilateral adrenalectomy showed a massive malignant melanoma in the adrenal glands, consistent with metastasis. Following that diagnosis, thorough studies revealed no ocular, mucocutaneous or primary tumor. The presence of melanoma in both adrenal glands favors metastatic melanoma over a primary adrenal melanoma.

What makes this case rare is the unusually great size of the symptomatic bilateral malignant melanoma adrenal metastasis of occult primary with wide hemorrhagic and necrotic areas, which was probably responsible for the patient's acute symptoms. The search for the primary tumor may be exigent, and it might not even be present at the time of diagnosis. Confirmation at autopsy is advisable, however this may not always be feasible.