ABSTRACT
A businessman in his thirties working in the USA developed an itchy raised pigmented naevus (mole) on his right flank which had gradually become darker, larger and itchy over a period of more than a year. He was urgently referred to a dermatologist, who rapidly saw the patient, made a diagnosis of malignant melanoma and excised the suspicious lesion. The nature of the mole removed from the right side was described in a histology report as showing malignant melanocytes (pigment-producing cells) extending directly into the upper dermis (upper layers of the skin) and into lower dermis (the deeper layers of the skin lying close to the blood and lymphatic vessels) by infiltration around hair follicles. The melanoma extended as deep as Clark’s level 4, which is the deepest and therefore most advanced local invasion observed in malignant melanomas of the skin, and the maximum thickness of the malignant melanoma was 4.5 mm, which meant that there was a poor prognosis with a 60% probability that the patient would be dead as a result of malignant melanoma within 10 years. There was, however, a prominent lymphocytic infiltrate at the tumour margins, suggesting that the patient was attempting to mount an immune response against the melanoma.
