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Annals of Clinical & Laboratory Science 38:157-162 (2008)
© 2008 Association of Clinical Scientists

Amelanotic Malignant Melanoma: Two Collision Tumors Presenting as Basal Cell Carcinoma and Atypical Fibroxanthoma

Douglas H. McGregor1, Rachel Cherian1, Maria M. Romanas1, Ozlem Ulusarac1, Sharad C. Mathur1 and Mary M. Feldman2
1 Pathology & Laboratory Medicine Service, Veterans Affairs Medical Center, Kansas City, Missouri, and Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas; 2 Division of Dermatology, Medical Subspecialty Care, Veterans Affairs Medical Center, Kansas City, Missouri; presently Departments of Dermatology and Pathology & Anatomical Sciences, University of Missouri, Columbia, Missouri

Address correspondence to Douglas H. McGregor, M.D., Veterans Affairs Medical Center, 4801 Linwood Bvld, Kansas City, MO 64128, USA; tel 816 861 4700, ext 52406; fax 816 922 3306; e-mail douglas.mcgregor{at}va.gov.

Collision (contiguous) tumors of the skin can result in misleading clinicopathological presentations, and the choice of appropriate diagnostic techniques may prevent incomplete diagnosis and management. We report 2 cases of collision tumors involving amelanotic malignant melanoma of the back. One patient is a 79-yr-old male with an 8.7 x 5.5 x 4.5 cm polypoid lesion that on shave biopsy was diagnosed as basal cell carcinoma. Subsequent excision showed that the lesion was largely composed of amelanotic melanoma underlying a relatively small and thin basal cell carcinoma, and this probably would have been demonstrated in a punch (rather than shave) biopsy. The other patient is a 71-yr-old male with a 1 cm exophytic lesion on the back, which was determined microscopically to be melanoma, and a 0.6 cm papule on the back. This lesion was composed of 2 distinct contiguous neoplastic infiltrates, the predominant component being an atypical fibroxanthoma and the smaller component an amelanotic melanoma (primary vs metastatic), with diagnostic confirmation requiring multiple immunohistochemical stains.

Keywords: melanoma, collision tumor, basal cell carcinoma, atypical fibroxanthoma






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