93-Year-Old Woman Misdiagnosed with Nipple Melanoma

A 93-year-old woman with an ulcerated lesion on her left nipple was misdiagnosed with undifferentiated sarcoma. After eight months of treatment, further examination confirmed invasive melanoma.

The lesion measured 3-4 cm and appeared as a firm, protruding mass. Imaging studies identified a suspicious mass and enlarged lymph nodes, but a fine-needle aspiration test showed no malignant cells. A modified radical mastectomy and axillary lymph node dissection were performed based on the initial diagnosis.

Post-surgery analysis revealed ulcerated invasive melanoma with significant Breslow thickness and a high mitotic rate. The tumor displayed varied cellular characteristics and mixed expression of melanocytic markers. The original biopsy’s negative results for crucial markers were later contradicted by additional immunohistochemical evaluations.

All lymph nodes removed were free of cancer, establishing the melanoma as Stage IIC. Due to the patient’s age, the medical team opted against adjuvant therapy. The patient remained disease-free 26 months after the diagnosis.

This case highlights the diagnostic challenges associated with nipple melanoma, a rare condition that can mimic other diseases. While mastectomy was performed based on the initial misdiagnosis, literature suggests that recent practices favor less aggressive treatments like wide local excision.

Nipple melanoma can resemble other conditions, including Paget disease and benign lesions. The case calls for a comprehensive approach to diagnosis, encouraging clinicians to include melanoma in differential diagnoses for persistent nipple abnormalities.