Resumen
Introducción: el melanoma maligno es una neoplasia de la piel que no suele invadir la mama, por lo que es infrecuente que se propague al tejido mamario de un paciente hombre. Cuando se disemina a la mama, puede manifestarse como una tumoración palpable o incluso ser asintomático. El ultrasonido permite detectar lesiones redondas e hipoecoicas, mientras que en la mamografía se observan nódulos definidos con aumento en la densidad. El objetivo es describir el abordaje de un paciente hombre con tumoración mamaria y una lesión sugestiva de melanoma, así como la importancia de la inmunohistoquímica para su adecuada diferenciación.
Caso clínico: paciente hombre de 72 años con lesión esternal pigmentada, un tumor axilar y un tumor mamario derecho de dos años de evolución. Fue tratado con resección, biopsia excisional y mastectomía simple, respectivamente. Se documentó melanoma de extensión superficial metastásico a mama derecha. La inmunohistoquímica respaldó el diagnóstico, tras encontrarse positividad para HMB-45 y S100 en las muestras examinadas.
Conclusiones: el melanoma metastásico en la mama de un paciente hombre es un hallazgo sumamente infrecuente. La inmunohistoquímica es fundamental tanto en el abordaje diagnóstico como en el pronóstico, ya que es útil en la determinación del manejo, el cual abarca intervenciones locales y sistémicas. Para pacientes que se presentan como el reportado en este caso, el tratamiento ideal consiste en resección amplia con disección ganglionar axilar, además de tratamiento sistémico adyuvante. Por lo anterior, es necesario el reporte de casos para dar a conocer el abordaje diagnóstico en este tipo de pacientes y poder ofrecer un manejo adecuado.
Abstract
Background: Malignant melanoma is a skin neoplasm that typically does not invade the breast, making its spread to the breast tissue in a male patient uncommon. When it metastasizes to the breast, it can present as a palpable mass or even be asymptomatic. Ultrasound allows for the detection of round hypoechoic lesions, while mammography detects well-defined nodules with increased density. The aim of this article is to describe the approach to a male patient with a breast mass and suspected melanoma, as well as the importance of immunohistochemistry for proper differentiation.
Clinical Case: A 72-year-old male patient presented with a pigmented lesion on the sternum, an axillary tumor, and a right breast mass, which had been evolving for the past two years. He underwent resection, excisional biopsy, and simple mastectomy, respectively. superficial spreading melanoma with right breast metastases was documented. Immunohistochemistry supported the diagnosis, after positivity for HMB-45 and S100 was found in the examined samples.
Conclusions: Metastatic melanoma in the male breast is an exceedingly rare finding. Immunohistochemistry plays a pivotal role in both diagnostic assessment and prognosis, as it guides treatment determination, which encompasses local and systemic interventions. For patients presenting as in this case, the optimal approach involves wide tumor resection with axillary lymph node dissection, coupled with adjuvant systemic therapy. Hence, case reporting is imperative to share diagnostic approaches in such patients and provide appropriate management strategies.
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