Melanoma with cutaneous melanoma secondaries.

Mr HG presented in 2002 with a large black lesion on his left loin. It had been present for many years but had recently changed (Figure 1). Nearby, two similar lesions were apparently separated by normal skin. Histology confirmed these were malignant melanoma. The 'normal' skin between lesions also demonstrated melanoma beneath the surface. At its thickest, this melanoma was a (Breslow) 2.56 mm, Clark 4 lesion. The tumour was excised with a minimum 20 mm margin of normal skin. Given the depth of the tumour, Mr HG was co-managed with the Victoria Melanoma Unit. There are no radiotherapy or chemotherapy programs that have been demonstrated to improve survival in patients with an advanced primary melanoma such as this. Following discussion, Mr HG chose not have a sentinel lymph node biopsy (SLNB).