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case_images: Pathology slides of the left chest wall mass. (A) Outside pathology slide diagnosed as poorly differentiated, high-grade spindle cell malignancy; (B) Outside pathology slide demonstrating focal, questionable positivity for HMB-45, initially leading to the diagnosis of melanoma; (C) Diffuse sheets of malignant cells diagnosed as high-grade malignant neoplasm at our institution; and (D) Multiple mitotic figures seen at our institution.
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case_images: A repeat biopsy was performed and compared to the outside biopsy specimen by our institution's pathologists ( Figures 1C, D ).
case_images: Baseline and interval imaging of the UPS of the chest wall. (A) PET CT on Month 0 showing the 16 cm invasive left axillary mass with FDG avidity and an indeterminate 5 mm pulmonary module; (B) CT angiography of the chest on Month 3 showing significant improvement in size of the left axillary chest wall mass at 10.2 cm with a stable 5 mm pulmonary nodule; and (C) CT of the chest on Month 8 showing stable post-surgical findings after extremity amputation without evidence of recurrent disease.
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case_images: Positron emission tomography-CT (PET-CT) demonstrated a 16 cm invasive left axillary mass with FDG avidity and an indeterminate 5 mm pulmonary nodule below PET resolution ( Figure 2A ). An interval CT of the chest demonstrated a significantly decreased size of the chest wall lesion from 17 cm to 10.2 cm ( Figure 2B ). After over two years of surveillance at the time of this writing, the patient has no evidence of disease ( Figures 2C ,  3 ).
case_images: Timeline of events and interval images of the chest wall lesion. (A) Anterior view of the left fungating chest wall mass (image from Month 1), (B) Posterior view after left forequarter amputation and skin/muscle flaps (image from Month 11), and (C) Posterolateral view on routine follow-up visit (Month 29).
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case_images: After over two years of surveillance at the time of this writing, the patient has no evidence of disease ( Figures 2C ,  3 ).