Net Case - Amelanotic malignant melanoma with multiple secondaries

A 37-year-old female presented with a fungating cauliflower-like growth over the right inguinal region with fracture of the right distal femur. Clinical examination revealed an asthenic individual and showed a large fungating protuberant mass over right inguinal region and right knee. Investigations revealed pancytopenia, massive splenomegaly with right iliac lymphadenopathy on ultrasonography of abdomen and a soft tissue mass over upper end of femur and fracture of distal femur on radiological examination. CT scan showed multiple deposits in the lungs with splenomegaly and lymphadenopathy. Fine needle aspiration cytology showed poorly cohesive cellular aspirate with spindle and round cell population with no pigment. Biopsy showed replacement of the dermis by coalescent nests of malignant melanocytes. S-100 antigen was found to be positive. The patient was diagnosed as a case of amelanotic malignant melanoma in Stage III disease and treated with general measures, stabilization of the fracture site followed by oncological management.