case_images: PMC11803228_01
case_images: Appearance of the left forearm.
case_images: gr1.jpg
case_images: PMC11803228_01_gr1.jpg
case_images: f0005
case_images: The larger mass (16 x 13 cm) extended from the elbow to the mid-forearm; a smaller mass (6.4 x 4.5 cm) was located opposite the lower third of the humerus (Fig. 1).
case_images: Magnetic Resonance Imaging revealed the two large masses on the left forearm. First large mass measuring 16 x 13 cm in T1 ponderation (A) and in T2 ponderation (B). Second mass measuring 7 cm x 8 cm in T1 ponderation (C) and in T2 ponderation (D).
case_images: gr2.jpg
case_images: PMC11803228_01_gr2.jpg
case_images: f0010
case_images: The CT-scan (computer tomography) and the MRI (Magnetic Resonance Imaging) showed the presence of two large, well-vascularized masses without bone or muscle involvement or metastases (Fig. 2).
case_images: Appearance of the left arm after excision surgery.
case_images: gr3.jpg
case_images: PMC11803228_01_gr3.jpg
case_images: f0015
case_images: EWSR1 transcripts in order to eliminate any doubts considering a potential clear cell sarcoma diagnosis, which were negative, a multidisciplinary team meeting and negative BRAF testing, a two-stage surgical approach was undertaken: complete excision of the tumor mass with clear surgical margins (10 mm) and subsequent skin grafting (Fig. 3). Excision surgery was possible considering that this melanoma was superficial and did not extend beyond the dermis.
case_images: Histological appearance of the forearm tumor.. HES stains at x25 (A) HES stains at x400 (B) Magnifications showing a nodular tumor made of round cells with solid and nested architectures. Tumor cell expression of MelanA (C), HMB45 (D), PS100 (E) and PRAME (F).
case_images: gr4.jpg
case_images: PMC11803228_01_gr4.jpg
case_images: f0020
case_images: In January and February 2024, the patient presented with new lesions: a nodular basal cell carcinoma on the right cervical region and an acrolentiginous melanoma (Breslow index 0.25 mm, Clark level II with in situ lateral component - Fig. 4) on the medial malleolus of the right foot (Fig. 5).