Melanoma cutáneo con debut ganglionar
Palabras clave:
melanoma, dermatoscopía, biopsia, metástasis linfática
Resumen
Entre 9–10% de melanomas debutan con afectación ganglionar regional y el tumor primario puede pasar inadvertido. El examen cutáneo de cuerpo entero y la dermatoscopía permiten la detección de melanomas primarios sutiles, mientras que la estadificación según la AJCC 8ª. orienta al tratamiento específico. Presentamos el caso de un varón de 56 años con una masa axilar derecha de tres meses de evolución, de crecimiento rápido e inicialmente indolora. Además, presentaba una tumoración en el brazo derecho de un año de evolución, que consideraba banal.
Tras la evaluación dermatológica se realizó biopsia escisional de la tumoración del brazo derecho. La histopatología, tanto ganglionar como tumoral, y la estadificación por imágenes confirmaron el diagnóstico de melanoma nodular ulcerado con afectación ganglionar (estadio IIIB), por lo que se inició inmunoterapia adyuvante anti-PD-1. Este caso destaca la secuenciación diagnóstica y la búsqueda activa del tumor primario.
Citas
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2. Amaral T, Ottaviano M, Arance A, Blank C, Chiarion-Sileni V, Donia M, et al. Cutaneous melanoma: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2025 [cited 2025 Sept 10];36(1):10-30. Available from: https://www.annalsofoncology.org/article/S0923-7534(24)04912-3/fulltext
3. National Cancer Institute. All cancer sites combined recent trends in SEER age-adjusted incidence rates, 2000-2022. [Internet]. USA: National Cancer Institute; 2025. [cited 2025 Sept 7]. Available from: https://seer.cancer.gov/statistics-network/explorer/application.html?site=53&data_type=1&graph_type=2&compareBy=stage&chk_stage_104=104&chk_stage_105=105&chk_stage_106=106&chk_stage_107=107&hdn_rate_type=1&sex=1&race=1&age_range=1&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0
4. Okobi OE, Abreo E, Sams NP, Chukwuebuni OH, Tweneboa Amoako LA, Wiredu B, et al. Trends in melanoma incidence, prevalence, stage at diagnosis, and survival: An analysis of the United States Cancer Statistics (USCS) Database. Cureus [Internet]. 2024 [cited 2025 Sept 7];16(2): e70697. Available from: https://pubmed.ncbi.nlm.nih.gov/39493095/
5. Watts CG, McLoughlin K, Goumas Ch, Van Kemenade CH, Aitken JF, Soyer HP, et al. Association between melanoma detected during routine skin checks and mortality. JAMA Dermatol [Internet]. 2021 [cited 2025 Sept 7];157(12):1425-36. Available from: https://pubmed.ncbi.nlm.nih.gov/34730781/
6. Dinnes J, Deeks JJ, Chuchu N, Ferrante di Ruffano L, Matin RN, Thomson DR, et al. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev [Internet]. 2018 [cited 2025 Sept 7];12(12):CD011902. Available from: https://pubmed.ncbi.nlm.nih.gov/30521682/
7. Cortez JL, Fadadu RP, Konda S, Grimes B, Wei ML. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int [Internet]. 2022 [cited 2025 Sept 7];7:78-85. Available from: https://pubmed.ncbi.nlm.nih.gov/35373156/
8. Scott JF , Gerstenblith MR. Melanoma of unknown primary. [Internet]. In: Noncutaneous melanoma. Brisbane (AU): Codon Publications; 2018. p. 99-116. [cited 2025 Sept 7]. Available from: https://exonpublications.com/index.php/exon/article/view/58
9. Swetter SM, Johnson D, Albertini MR, Barker ChA, Bateni S, Baumgartner J, et al. NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024. J Natl Compr Canc Netw [Internet]. 2024 [cited 2025 Sept 7];22(5):290-8. Available from: https://pubmed.ncbi.nlm.nih.gov/39019054/
10.Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, et al. Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin [Internet]. 2017 [cited 2025 Sept 7];67(6):472-92. Available from: https://pubmed.ncbi.nlm.nih.gov/29028110/
11.Eggermont AM, Kicinski M, Blank ChU, Mandala M, Long GV, Atkinson V, et al. Seven-year analysis of adjuvant pembrolizumab versus placebo in stage III melanoma in the EORTC1325 / KEYNOTE-054 trial. Eur J Cancer [Internet]. 2024 [cited 2025 Sept 7]; 211:114327. Available from: https://pubmed.ncbi.nlm.nih.gov/39288737/ Subscription required
12.Sussman TA, Ott PA. Adjuvant immunotherapy for melanoma patients: progress and opportunities. ESMO Open [Internet]. 2024 [cited 2025 Sept 7];9(5):102962. Available from: https://pubmed.ncbi.nlm.nih.gov/38626633/
13.Patel SP, Othus M, Chen Y, Wright GP, Yost KJ, Hyngstrom JR, et al. Neoadjuvant–Adjuvant or Adjuvant-Only Pembrolizumab in advanced melanoma. N Engl J Med [Internet]. 2023 [cited 2025 Sept 7];388(9):813-23. Available from: https://pubmed.ncbi.nlm.nih.gov/36856617/
14.Prieto VG, Shea ChR. Immunohistochemistry of melanocytic proliferations. Arch Pathol Lab Med [Internet]. 2011 [cited 2025 Sept 7];135(7):853-9. Available from: https://pubmed.ncbi.nlm.nih.gov/21732774/
