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2012 ; 51
(4
): 420-6
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Amelanotic melanomas presenting as red skin lesions: a diagnostic challenge with
potentially lethal consequences
#MMPMID22435430
McClain SE
; Mayo KB
; Shada AL
; Smolkin ME
; Patterson JW
; Slingluff CL Jr
Int J Dermatol
2012[Apr]; 51
(4
): 420-6
PMID22435430
show ga
OBJECTIVE: To characterize epidemiologic and clinical features of red primary
amelanotic melanomas, an atypical presentation of melanoma that is
underemphasized in patient and physician education. PATIENTS AND METHODS: Review
of a prospectively collected melanoma database identified 46 patients with red
amelanotic melanomas, whose clinical features were compared with 329 patients
with pigmented melanomas from the same database and same timeframe from January
1964 to September 2005. RESULTS: Red amelanotic melanomas represented 3.9% of all
melanomas recorded in our database and accounted for nearly 70% of amelanotic
melanomas. Melanoma was included in the clinical differential diagnosis in 32% of
red amelanotic melanomas vs. 94% of pigmented melanomas (P<0.001). Red amelanotic
melanomas more commonly underwent shave biopsy (55 vs. 12%, P<0.001) and more
likely had positive deep margins (35 vs. 9%, P<0.001) but had comparable risks of
metastasis and mortality. CONCLUSION: Red amelanotic melanomas are often
misdiagnosed clinically but carry a mortality risk comparable to pigmented
melanomas. Clinicians screening for melanoma should be more vigilant in
considering melanoma in the differential diagnosis of red skin lesions.