case_images: PMC9773131_01
case_images: PMC9773131_02
case_images: Heterogeneous brown-to-black patches and plaques with satellite lesions, areas of hypertrichosis and irregular borders, consistent with partially-excised giant congenital melanocytic nevus. (A) Scattered lesions over the lower abdomen. (B) Scattered lesions over the posterior thorax and buttocks. (C) Right mid-back nodular area where the initial incisional biopsy was performed.
case_images: fmed-09-1086473-g0001.jpg
case_images: PMC9773131_02_fmed-09-1086473-g0001.jpg
case_images: F1
case_images: During bedside evaluation, the patient was found to have heterogeneous brown-to-black patches/plaques scattered on his torso, buttocks, and lower abdomen with satellite lesions, areas of hypertrichosis, and irregular borders, consistent with partially-excised giant CMN of bathing trunk distribution (Figure 1).
case_images: Histopathologic examination of the sample obtained by incisional biopsy of the right axillary nodule. (A) H&E stain (20 x magnification), showing innumerous irregularly-shaped tumor cells with nuclear hyperchromasia and prominent nucleoli intermixed within fibroadipose tissue. (B) Immunostaining for S100 (10 x magnification) showing diffuse nuclear and cytoplasmic positivity in all tumor cells. (C) Immunostaining for melan-A (10 x magnification) showing diffuse cytoplasmic positivity in all tumor cells. (D) Immunostaining for PRAME (10 x magnification) showing diffuse nuclear positivity in all tumor cells.
case_images: fmed-09-1086473-g0002.jpg
case_images: PMC9773131_02_fmed-09-1086473-g0002.jpg
case_images: F2
case_images: As a result, the patient underwent an incisional biopsy of the right axillary nodule, with formalin-fixed paraffin-embedded (FFPE) samples revealing malignant cells within fibroadipose tissue (Figure 2).
case_images: Timeline of the patient's clinical course and melanoma-directed therapy. CVT, Cisplatin/vinblastine/temozolomide; IPI, Ipilimumab; M1D, Metastasis to the central nervous system, with or without involvement of other sites; NIVO, Nivolumab; PD, Progressive disease; RELA, Relatlimab; SD, Stable disease; SB, Small bowel; TIL, Tumor-infiltrating lymphocytes.
case_images: fmed-09-1086473-g0003.jpg
case_images: PMC9773131_02_fmed-09-1086473-g0003.jpg
case_images: F3
case_images: Figure 3 showcases a timeline with relevant data from the patient's clinical course.