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Abstract: A mole that had existed in the palm of the left hand for 10 years suddenly increased in size in recent January, and also showed abnormal manifestations such as itching and pain, so the patient came to the clinic and was diagnosed as malignant melanoma, and the patient’s condition was controlled through surgical treatment. Malignant melanoma is a kind of skin malignant tumor with rapid growth and high malignancy, which mostly comes from the malignant transformation of moles. Therefore, once a sudden change in the size, shape, and color of a skin mole that has existed for many years is detected, you need to seek medical attention to confirm the diagnosis and treatment as soon as possible.
Basic information】Female, 55 years old
Disease Type】Malignant melanoma
Hospital】The Second Hospital of Guangzhou Medical University
Date of Consultation】November 2020
Treatment plan] Left upper limb amputation + ipsilateral axillary lymph node dissection + targeted therapy (dabrafenib mesylate capsule + trametinib tablet)
Treatment period] 14 days of inpatient surgery, six months of follow-up
Treatment effect】Good recovery, no recurrence of disease found in six months after surgery
I. Initial consultation
A 55-year-old sister Zhao was admitted to the hospital with a sudden enlargement of a skin nevus on her left palm that had been present for more than 10 years for one month. The patient had a nevus on her left palm for more than 10 years, and she unintentionally noticed the rapid increase of the nevus one month ago. On physical examination, a skin nevus of about 0.8cm×0.5cm in size was found in the interphalangeal area of the left hand with unclear boundary, and a pigeon egg-sized lymph node could be felt in the ipsilateral axilla. The preliminary diagnosis was that the skin nevus was enlarged and the possibility of malignant melanoma was high.
Treatment history
After admission, the patient was given CT scan and enhanced examination of the chest and abdomen, suggesting that multiple masses of different sizes were seen in the left axilla, which were considered to be enlarged lymph nodes. A skin excisional biopsy was performed in the dermatology department, and the pathological examination was reported to be a nodular malignant melanoma of the left palm, which was diagnosed as malignant melanoma of the left palm with axillary lymph node metastasis according to the examination results. After detailed explanation to the patient and family, amputation of the left upper limb and ipsilateral axillary lymph node dissection were performed. However, the patient said he could not accept the amputation. After repeatedly communicating with him and his family about the necessity and importance of amputation, the patient finally changed his mind and agreed to the surgery. The postoperative pathological examination suggested malignant melanoma with tumor infiltration depth >4mm, negative margins, 2/15 left axillary lymph node metastases, and positive BRAF V600 mutation in the gene test.
III. Treatment results
The patient recovered well after surgery and was discharged at 14 days of hospitalization, and now she has been fitted with a prosthesis and can basically take care of herself in daily life. The whole-body PET-CT scan was performed and no abnormal increase in metabolism was detected, and no sign of tumor recurrence was considered. In addition, the patient had a three-month-long period of depression after amputation, refusing all communication with family, friends and doctors. With the joint care and help of her family and psychiatrist, she has now come out of the psychological shadow of physical disability and can face the physical disability openly and integrate into her family and social life actively.
IV. Notes
We are glad that the patient has recovered well after treatment, but due to the high malignancy of malignant melanoma, even if the surgery can be completely removed, the recurrence rate is still high, and the main manifestation of recurrence is usually lymph node metastasis. Therefore, patients must pay more attention to the changes of their body after discharge from the hospital, especially whether there are any new lumps or enlarged lymph nodes in the neck, upper and lower clavicle, armpit, groin, etc. If there are, they should go to the hospital immediately to prevent recurrence and metastasis. In addition, after amputation surgery for malignant melanoma patients in the limb area, the psychological impact on the patient is large, and sometimes psychological intervention is very necessary. Moreover, the functional exercise of amputation patients after the installation of prosthesis is more important for the smooth integration of patients into society, and should be given sufficient attention. Finally, the diet should pay attention to nutrition, avoid greasy, spicy, high-quality protein diet and diet rich in dietary fiber.
V. Personal insight
For malignant tumors with high disability and mortality rate, the best treatment is always prevention, so the primary and secondary prevention of malignant tumors should be a mandatory course. The progress of the society and the development of the civilization put higher and higher demands on the doctors, who should not only control the physical diseases of the patients, but also be good at relieving their psychological problems. The psychological rehabilitation of the patient after the amputation in this case is a relatively successful example.