case_images: PMC10559153_01
case_images: well demarcating irregular hyperpigmenting patch seen at the base of the right fifth toe plantar aspect which extends to the space between the 4th and 5th toes
case_images: PAMJ-45-141-g001.jpg
case_images: PMC10559153_01_PAMJ-45-141-g001.jpg
case_images: F1
case_images: There is a well demarcated irregular hyperpigmented patch seen at the base of right fifth toe plantar aspect which extends to the space between 4th and 5th toes (Figure 1), with no lymphadenopathy or splenomegaly noted.
case_images: large lesions seen in the T8 vertebra with epidural extension of disease and spinal cord compression
case_images: PAMJ-45-141-g002.jpg
case_images: PMC10559153_01_PAMJ-45-141-g002.jpg
case_images: F2
case_images: Large bone lesions were seen in the T8 vertebra with epidural extension of disease and spinal cord compression, and multilevel degenerative changes on lumbar spine area (Figure 2).
case_images: melanoma at right foot; A) at intermedium magnification (100 x), the atypical melanocytes infiltrate asymmetrically in the ulcerated upper dermal tissue, the melanin incontinence is present; B) at high magnification (400 x), the invasive components of oval to spindle atypical cells admixed with macrophages
case_images: PAMJ-45-141-g003.jpg
case_images: PMC10559153_01_PAMJ-45-141-g003.jpg
case_images: F3
case_images: T7-9 posterior fusion through neurosurgery. The biopsy of the right plantar foot lesion showed segment of dermis containing atypical melanocytic proliferation (Figure 3). Thoracic spinal epidural tumor showed sheets of atypical melanocytes present in the spinal tissue (Figure 4,
case_images: metastatic melanoma in spine; A) at intermedium magnification (100 x), the sheets of atypical melanocytes present in the spinal tissue; B) at high magnification (400 x), the majorities of the atypical melanocytes are oval and spindle cells with vesicular nuclei
case_images: PAMJ-45-141-g004.jpg
case_images: PMC10559153_01_PAMJ-45-141-g004.jpg
case_images: F4
case_images: the metastatic melanoma in spine; the neoplastic cells diffusely and strongly express the Sox10, S-100 and melanin, which confirms the diagnosis of metastatic malignant melanoma; the metastatic melanoma in spine; the melanoma demonstrates 60-70% proliferative rate
case_images: PAMJ-45-141-g005.jpg
case_images: PMC10559153_01_PAMJ-45-141-g005.jpg
case_images: F5
case_images: The tumor cells were immunoreactive to Sox-10, S-100, melanA, HMB-45, CD56 and not immunoreactive to AE1/AE3, CAM5.2, Desmin, GFAP, and SYN which is consistent with malignant melanoma, the ki-67 was 60-70% (Figure 5). The Ct DNA (liquid biopsy): NTRK1 A635T 1% VUS with next gen sequencing was negative for actionable mutation.