Ovarian malignant melanoma metastasized from skin mimicking a benign cyst: a rare case report and mini-review of the literature

Malignant melanomas, often appearing on the skin, rarely metastasize to internal organs and the ovaries are the least affected site. A 45-year-old female patient presenting with a skin lesion on the right side of the neck and diagnosed with malignant melanoma through excision biopsy also appeared to have lung metastasis and a nonspecific ovarian cystic mass of 6 cm after PET-CT scan was performed. Examination revealed a mass with the widest diameter of 9 cm and a surgical decision was made due to the rapid growth pattern. Tumor markers appeared to be within the normal range. Laparoscopic right salpingoopherectomy was performed and frozen section biopsy was obtained. The result was found to be malignant and complementary surgery was performed. Pathological examination of the cystic mass, which was detected to have only nonspecific findings on radiological exam, revealed tiny solid areas in its capsule. The patient was started on postoperative Dabrafenib + Trametinib treatment by oncology and was followed up without recurrence until the 24th postoperative month. At month 24, the brain metastasis with no response to radiotherapy occurred and the patient was lost on the 15th day after decompression surgery. It is important to send adnexal masses to the frozen even if they appear to have a benign character. In patients with a known history of primary cancer, the possibility of the metastasis from the primary tumor site to the ovary should be considered in those whose peroperative frozen section result is in favor of malignancy. Our case is the first case of ovarian malignant melanoma metastasis with a completely cystic and septa-free character in the literature.

Keywords:

Metastasis, ovarian malignant melanoma, ovary cyst, survey,

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1. Schadendorf D, van Akkooi ACJ, Berking C, Griewank KG, Gutzmer R, Hauschild A, et al. Melanoma. Lancet 2018;392:971-84.
2. Cancer Genome Atlas Network. Genomic Classification of cutaneous melanoma. Cell 2015;161:1681-96.
3. Lynch HT, Fusaro RM, Danes BS, Kimberling WJ, Lynch JF. A review of hereditary malignant melanoma including biomarkers in familial atypical multiple mole melanoma syndromes. Cancer Genet Cytogenet 1983;8:325-58.
4. Piura B, Kedar I, Ariad S, Meirovitz M, Yanai-Inbar I. Malignant melanoma metastatic to the ovary. Gynecol Oncol 1998;68:201-5.
5. Oliver R, Dasgupta C, Coker A, Al-Okati D, Weekes ARL. Ovarian malignant melanoma: unusual presentation of a solitary metastasis. Gynecol Oncol 2005;99:412-4.
6. Choi WK, Lee DH, Cho DH, Jang KY, Kim KM. Primary malignant melanoma arising from ruptured ovarian mature cystic teratoma with elevated serum CA 19-9: a case report and review of the literature. BMC Women Health 2019;27:149.
7. Young RH, Scully RE. Malignant melanoma metastatic to the right ovary. A clinicopathologic analysis of 20 cases. Am J Surg Pathol 1991;15:849-60.
8. Mendel A, Terzibachian JJ, Aubin F, Malicenco L, Ramanah R, Riethmuller D. Ovarian metastasis of malignant melanoma: a case report. J Gynecol Obstet Hum Reprod 2017;46:461-2.
9. Gupta D, Deavers MT, Silva EG, Malpica A. Malignant melanoma involving the ovary: a clinicopathologic and immunohistochemical study of 23 cases. Am Surg Pathol 2004;28:771-80.
10. Pavri SN, Clune J, Ariyan S, Narayan D. Malignant melanoma: beyond the basics. Plast Reconstr Surg 2016;138:330e-40e.
11. Karateke A, Tuğ N, Sahin D. Metastatic ovarian malignant melanoma with no obvious primary. J Turk Ger Gynecol Assoc 2011;12:181-2.
12. Sabban F, Boukerrou M, Mubiayi N, Houpeau JL, Robert Y, Vinatier D. [Malignant melanoma metastatic to the ovary. A case report]. Gynecol Obstet Fertil 2005;33:409-11. [Article in French]
13. Fitzgibbons PL, Martin SE, Simmons TJ. Malignant melanoma metastatic to the ovary. Am J Surg Pathol 1987;12:959-64.
14. Sbitti Y, Fadoukhair Z, Kadiri H, Oukabli M, Essadi I, Kharmoum S, et al. Diagnostic challenge for ovarian malignant melanoma in premenopausal women: primary or metastatic? World J Surg Oncol 2011;9:65.