case_images: PMC3420798_01
case_images: Gross view of the skin lesion on the plantar. The lesion measures 6 x 5 cm with an ulcerated area at the base of fourth and fifth metatarsal involving the interdigital cleft and extending to the forefoot.
case_images: CRIM.ENDOCRINOLOGY2012-502806.001.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.001.jpg
case_images: fig1
case_images: Physical exam was unremarkable except for an ulcer on the plantar aspect on his right forefoot measuring 6 x 5 cm with an ulcerated area at the base of fourth and fifth metatarsal involving the interdigital cleft and extending to the forefoot (Figure 1).
case_images: Thickened epidermis ulcerated with many heavily pigmented malignant melanocytes (H and E Stains, 40x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.002.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.002.jpg
case_images: fig2
case_images: The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
case_images: Epidermis and dermis with pigmented malignant melanocytes (H and E stains, 100x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.003.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.003.jpg
case_images: fig3
case_images: The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
case_images: Atypical tumor cells, some pigmented, some not, with large irregular nuclei with large nucleoli. Spindled and round tumor cells. Heavy cytoplasmic melanin pigment (H and E stains, 400x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.004.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.004.jpg
case_images: fig4
case_images: The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
case_images: Dermal involvement of tumor cells with uninvolved adjacent deep dermis (H and E stains, 40x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.005.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.005.jpg
case_images: fig5
case_images: The tumor had an ulcerated surface that permeated the papillary and reticular dermis without permeation of subcutaneous tissue, suggestive of a Clarke level 4 (Figures 2, 3, 4, and 5).
case_images: Right groin sentinel lymph node with heavy tumor cell involvement (H and E stains, 40x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.006.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.006.jpg
case_images: fig6
case_images: Patient's sentinel lymph node biopsy was positive for lymph node metastasis (Figures 6 and 7), and his tumor staging, according to the American Joint Committee on Cancer (AJCC) system of TNM (tumor, node, and metastasis) classification, was stage IIIb (T3bN1bM0).
case_images: Tumor cells contrasted with benign lymphocytes of lymph node (Hand E stains, 400x).
case_images: CRIM.ENDOCRINOLOGY2012-502806.007.jpg
case_images: PMC3420798_01_CRIM.ENDOCRINOLOGY2012-502806.007.jpg
case_images: fig7
case_images: Patient's sentinel lymph node biopsy was positive for lymph node metastasis (Figures 6 and 7), and his tumor staging, according to the American Joint Committee on Cancer (AJCC) system of TNM (tumor, node, and metastasis) classification, was stage IIIb (T3bN1bM0).