Delayed diagnosis of metastatic melanoma reoccurrence: Case report

This case report describes a 72-year-old patient with delayed diagnosis of metastatic melanoma reoccurrence. The original case of melanoma was excised from his left knee, arm, and torso in 2012. 2016 found the patient with metastatic melanoma biopsy positive to his back, to which the patient trialed pembrolizumab therapy but was unable to tolerate the gastrointestinal side effects. 2019 saw another reoccurrence of metastatic melanoma with CT CAP positive left inguinal lymphadenopathy and MRI positive intraosseous mass of the left calcaneus, both biopsy-proven melanoma. Due to these findings, the patient was started on encorafenib and binimetinib April of 2019, and by December of 2019, PET scan showed near complete resolution of the mass. Prior to seeing a new PCP, the patient attested that the leg growth had occurred and been increasing in size for 6 months. His oncologist did not comment on the nodular lesion at any point in his notes from visits during the same 6-month period, and a prior ER physician prescribed doxycycline to treat presumed cellulitis versus malignancy. The current PCP sent the patient for CT of the left leg in November of 2023; the patient was then sent to his oncologist where FNA was performed and supported the diagnosis of metastatic melanoma. Verily, this case report brings light to the notion that providers should have a high degree of suspicion of metastasis in patients such as this one and not delay definitive diagnosis, especially when there are obvious cutaneous manifestations.