Soft tissue masses of the chest wall and axilla - Has metastatic melanoma been considered?

Isolated axillary and chest wall soft tissue masses are an uncommon present ation of metastatic cancer. The authors present three patients in whom mali gnant melanomas metastatic to these sites had been misdiagnosed, leading to inappropriate oncologic treatment planning in all three cases. The presume d diagnoses, even after fine-needle aspiration or trucut biopsies, were sof t-tissue sarcoma (n = 2) and undifferentiated breast cancer (n = 1). The co mbination of taking a thorough history and performing proper immunohistoche mical analysis of the biopsy material would have suggested the presence of malignant melanoma in all cases. As the disease appeared locoregionally lim ited in all patients, radical surgical resection with extended lymphadenect omy was performed without significant dysfunction of the upper extremity. O ne patient agreed to postoperative immunotherapy with interferon-alpha. Two patients are currently alive 17 and 14 months after operation. One patient was found to have systemic recurrence at 5 months, one experienced two iso lated local recurrences in a prior operative site that were amenable to rer esection and presently has no evidence of disease 12 months after resection , and one patient remains free of disease at 14 months. Clinical presentati on, suggested diagnostic workup, and therapeutic implications are discussed to avoid misdiagnoses in this setting of possible clinical presentations o f metastatic melanoma.