Primary Regressive, But Metastasizing Melanoma!?

Cases of regressive melanomas represent a diagnostic and therapeutic challenge because time intervals between the presence of the primary tumour formation, the metastasis and the involution of the primary tumour may intertwine or occur at different times. The regression of cutaneous melanomas does not necessarily guarantee prevention from the development of locoregional or distant metastases. There are cases in which the prognosis of patients with the development of subsequent metastasis within regressive melanomas may be better depending on the number and location of metastases.

We are presenting a 42-year-old patient with two timed removals of enlarged inguinal lymph nodes within one year, as the subsequent histological examination identified histopathological data for metastasis of melanoma. BRAF testing was positive for BRAF mutation. Within the anamnesis, it was further clear that the patient had an irritated melanocytic lesion in the lateral right thigh area, which over the time disappeared and shortly after that, the enlargement of locoregional lymph nodes has been noted.

In the presented case prognosis and therapeutic options for treatment of patients with regression melanomas and subsequent development of lymph node metastasis have been discussed. Currently, there is no consentaneous opinion on the applicability of the early adjuvant therapy with targeted therapies or immunotherapy in patients with regressive and non-regressive type melanomas. We suggest and share the idea that early adjuvant therapy may be beneficial generally in patients with stage III melanomas.