Multiple cutaneous malignant melanomas with features of primary melanoma

A case report and review of the literature regarding multiple primary melanomas, and a discussion of the histologic differentiation between cutaneous primary melanomas and dermal metastases are presented. This report concerns a patient who, following wide surgical resection of a 1.3 mm thick primary melanoma with satellite lesions, developed eight additional primary lesions and more than 50 dermal metastases. The primary nature of the lesions was confirmed by detailed pathologic study. The patient was rendered free of disease over a two-year period of intralesional injection of Bacillus Calmette-Guerin (BCG) and purified tuberculin protein. This was accompanied by substantial improvement in immune function tests. Although this patient represents an uncommon clinical entity, treatment results suggest that aggressive intralesional immunotherapy may complement surgical resection in achieving successful palliation of patients with multiple primary melanomas.