Symbiotic lymph node metastasis from breast cancer and melanoma

Description

A 93-year-old woman with a history of stage 4 breast cancer and stage T4a melanoma presented with pain in her left buttock and groin area. Her breast cancer type was invasive lobular carcinoma, 100% oestrogen receptor positive with normal expression of human epidermal growth factor receptor 2. She had osteosclerotic vertebral metastases at the time of diagnosis and was treated medically with an aromatase inhibitor and an osteoclast inhibitor. Her melanoma had been of polypoid, nodular subtype with Breslow's thickness 6.8 mm, no ulceration and 15 mitoses per mm². The maximal diameter was 2 cm, and it was resected surgically with a 0.5 cm margin.

At current presentation, focal relapse of melanoma of the buttock, with metastases to inguinal lymph nodes, was suspected. Local excision with a 0.5 cm margin and lymph node dissection were performed for diagnostic and palliative purposes (figure 1). Histological examination confirmed melanoma relapse located...

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