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A male 15-year-old captive Siberian tiger (Panthera tigris altaica) developed pelvic limb hypermetry over the past 10 years. Recently, an ulcerated black nodule located caudally to the right ear was observed. The animal was submitted to surgery for removing the tumor, but died during anesthetic recovery. At necropsy, another infiltrative nodule was observed caudally to the right ear. Histologically, both nodules corresponded to melanocytic neoplasia, varying from heavily pigmented to amelanotic, with metastasis to mediastinal lymph nodes, spleen and lung. Lipofuscinosis and corpora amylacea were histologically observed in the central nervous system. Macroscopic and histologic findings confirmed the diagnosis of skin metastatic melanoma in a captive adult Siberian tiger. RESUMO Um tigre-siberiano (Panthera tigris altaica) de cativeiro, macho, de 15 anos de idade, apresentou hipermetria dos membros pélvicos nos últimos 10 anos, e recentemente, foi observado um nódulo preto e ulcerado caudalmente à orelha direita. O animal foi submetido à cirurgia para remoção do nódulo e morreu durante a recuperação anestésica. À necropsia, outro nódulo infiltrativo, foi detectado caudalmente a orelha direita. Histologicamente, ambos os nódulos correspondiam à neoplasia melanocítica, com células variando de fortemente pigmentadas a amelanóticas, com metástase para linfonodos mediastinais, baço e pulmão. Havia lipofucsinose e corpora amilácea no sistema nervoso central. Os achados macroscópicos e histológicos confirmam o diagnóstico de melanoma cutâneo metastático em um tigre-siberiano adulto de cativeiro.

ResumenEl melanoma es una neoplasia cutánea común que ha alcanzado gran importancia en las últimas décadas debido al aumento en su incidencia y a su comportamiento agresivo, con metástasis ganglionares y a distancia frecuente. La biopsia, en caso de sospecharse melanoma, debe ser escisional, con el objetivo de obtener información histológica completa y analizar factores de mal pronóstico, como ulceración, número de mitosis y el Breslow, que influyen en la estadificación preoperatoria del paciente y en la decisión de realizar biopsia de ganglio centinela o no. La escisión local amplia es el manejo indicado para el melanoma con márgenes periféricos de piel normal ya establecidos de acuerdo al Breslow y a la localización del tumor. La linfadenectomía terapéutica es el tratamiento recomendado de los pacientes con melanoma que tienen ganglios linfáticos clínica o radiológicamente positivos.En este artículo se realiza una revisión del tratamiento quirúrgico del melanoma, la toma adecuada de biopsia de lesiones sospechosas, los factores histológicos adversos, las indicaciones de biopsia del ganglio centinela y de linfadenectomía radical. Además se revisan situaciones especiales en las cuales el manejo del melanoma difiere por su localización (acral plantar, subungueal, lentigo maligno) o diagnóstico durante el embarazo.AbstractMelanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes.This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy.Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.

Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes.This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy.Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.

ResumenAntecedentesDesde la introducción de la biopsia selectiva del ganglio centinela, su utilización en pacientes con melanoma cutáneo y ganglios clínicamente negativos permanece controvertido. Hemos evaluado nuestra experiencia en biopsia selectiva del ganglio centinela en pacientes con melanoma.Material y métodosEstudio retrospectivo observacional, en el que hemos estudiado una muestra de 69 pacientes diagnosticados de melanoma cutáneo primario sin evidencia clínica de afectación metastásica, a los que se realizó biopsia selectiva del ganglio centinela desde octubre de 2005 hasta diciembre de 2013. El ganglio centinela fue identificado mediante una linfogammagrafía preoperatoria y posterior detección intraoperatoria con sonda gammadetectora.ResultadosLa tasa de identificación del ganglio centinela fue del 98.5%. El ganglio centinela fue positivo en 23 pacientes (33.8%). Las complicaciones postoperatorias después de la biopsia selectiva del ganglio centinela fueron observadas en el 4.4%, frente al 38% de los pacientes sometidos a linfadenectomía.ConclusiónLa biopsia selectiva del ganglio centinela en pacientes con melanoma proporciona valiosa información sobre las vías de diseminación linfática del tumor, y también permite una aproximación a la estadificación regional del mismo, evitando los efectos secundarios de la linfadenectomía. No obstante, serían necesarios estudios de mayor tamaño muestral y tiempo de seguimiento para confirmar la validez de la técnica de la biopsia selectiva del ganglio centinela en pacientes con melanoma, y especialmente de la linfadenectomía en casos de ganglio centinela positivo.AbstractBackgroundSince the introduction of sentinel lymph node biopsy, its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. Our experience of sentinel lymph node biopsy for melanoma is presented and evaluated.Material and methodsA cohort study was conducted on 69 patients with a primary cutaneous melanoma and with no clinical evidence of metastasis, who had sentinel lymph node biopsy from October-2005 to December-2013. Sentinel lymph node biopsy was identified using preoperative lymphoscintigraphy and subsequent intraoperative detection with gamma probe.ResultsThe sentinel lymph node biopsy identification rate was 98.5%. The sentinel lymph node biopsy was positive for metastases in 23 patients (33.8%). Postoperative complications after sentinel lymph node biopsy were observed in 4.4% compared to 38% of complications in patients who had complete lymphadenectomy.ConclusionThe sentinel lymph node biopsy in melanoma offers useful information about the lymphatic dissemination of melanoma and allows an approximation to the regional staging, sparing the secondary effects of lymphadenectomy. More studies with larger number of patients and long term follow-up will be necessary to confirm the validity of sentinel lymph node biopsy in melanoma patients, and especially of lymphadenectomy in patients with positive sentinel lymph node biopsy.

El melanoma cutáneo es una neoplasia cuya incidencia va en aumento en nuestro medio. Presentamos un estudio sobre 1023 casos de esta patología recogidos a lo largo de 20 años, distribuidos en 2 grupos: grupo A tratados antes del 2000, y grupo B tratados después del 2000. Comparamos la supervivencia de ambos grupos en base al cambio de tratamiento por la introducción del estudio del ganglio centinela a partir del año 2000. No observamos diferencias significativas entre los 2 grupos en la supervivencia de los pacientes con melanoma a pesar de realizar tratamientos más conservadores. Por tanto, gracias a la biopsia de ganglio centinela, se pueden evitar un 75% de linfadenectomías electivas realizadas en este tipo de patología sin modificar los índices de supervivencia.

Background Since the introduction of sentinel lymph node biopsy, its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. Our experience of sentinel lymph node biopsy for melanoma is presented and evaluated. Material and methods A cohort study was conducted on 69 patients with a primary cutaneous melanoma and with no clinical evidence of metastasis, who had sentinel lymph node biopsy from October-2005 to December-2013. Sentinel lymph node biopsy was identified using preoperative lymphoscintigraphy and subsequent intraoperative detection with gamma probe. Results The sentinel lymph node biopsy identification rate was 98.5%. The sentinel lymph node biopsy was positive for metastases in 23 patients (33.8%). Postoperative complications after sentinel lymph node biopsy were observed in 4.4% compared to 38% of complications in patients who had complete lymphadenectomy. Conclusion The sentinel lymph node biopsy in melanoma offers useful information about the lymphatic dissemination of melanoma and allows an approximation to the regional staging, sparing the secondary effects of lymphadenectomy. More studies with larger number of patients and long term follow-up will be necessary to confirm the validity of sentinel lymph node biopsy in melanoma patients, and especially of lymphadenectomy in patients with positive sentinel lymph node biopsy.

ResumenAntecedentesLa mortalidad del melanoma cutáneo no ha disminuido en los últimos 50 años. Las únicas medidas que permiten reducirla son la prevención primaria y el diagnóstico oportuno; la evaluación dermatoscópica es fundamental para lograrlo. Permite identificar características del melanoma que pasarían desapercibidas al ojo desnudo.El objetivo es reportar los hallazgos dermatoscópicos más frecuentes en pacientes con diagnóstico de melanoma in situ e invasivo.Material y métodosEstudio observacional, retrospectivo en el que se realizó dermatoscopia de contacto utilizando dermatoscopio LED DermliteMR, y cámara fotográfica DermliteMR. Se evaluó asimetría en 2 ejes, asociación de colores, falta de pigmento, puntos irregulares, red atípica, pseudópodos, velo azul, ulceración y anillo rosa perilesional, y se comparó el diagnóstico histológico con los hallazgos dermatoscópicos.ResultadosFueron 65 pacientes con melanoma cutáneo: 10 in situ y 55 invasivos. La media de Breslow en invasivos fue 3mm. La mayoría de los pacientes (35) tuvieron localización en extremidades. El hallazgo dermatoscópico más frecuente fue asimetría en 2 ejes, seguida de asociación de 2 o más colores; en melanoma in situ el hallazgo más habitual fue la asimetría en 2 ejes seguida de los puntos atípicos; en melanoma invasivo la asimetría en 2 ejes, la asociación de 2 colores o más y los pseudópodos fueron los hallazgos más frecuentes.ConclusiónLa asimetría en 2 ejes es el hallazgo dermatoscópico más frecuente en melanoma ya sea in situ o invasivo; la presencia de 2 colores o más en una lesión pigmentada debe hacer sospechar de un melanoma invasivo.AbstractBackgroundThe mortality of cutaneous melanoma has not declined over the past 50 years. The only interventions that can reduce mortality are primary prevention and early diagnosis, and the dermoscopic evaluation is essential to achieve this. Dermoscopy identifies characteristics of melanoma that would go unnoticed to the naked eye.The aim of this paper is to report the most frequent dermoscopic findings in patients diagnosed with in situ and invasive melanoma.Material and methodsAn observational and retrospective study of contact dermoscopy was performed using LED DermliteTM and camera DermliteTM dermoscope. The findings evaluated were: asymmetry in two axes, association of colours, lack of pigment, irregular points, atypical network, pseudopods, blue veil, ulceration, and peri-lesional pink ring. These dermoscopic findings were compared with the histological diagnosis.ResultsThe study included 65 patients with cutaneous melanoma; 10 in situ, and 55 invasive. The mean Breslow in invasive melanoma was 3 mm. Most patients (35) had localization in extremities. In all patients, the most frequent dermoscopic finding was asymmetry in two axes, followed by association of two or more colours; in melanoma in situ, asymmetry was the most frequent, followed by atypical-irregular points. In invasive melanoma asymmetry in two axes, the association of two or more colours, and pseudopods, were the most frequent findings.ConclusionAsymmetry in two axes is the most common dermoscopic finding in in situ and invasive melanoma. The presence of two or more colours in a pigmented lesion should be suspected in an invasive melanoma.

RESUMEN Introducción: es sabido que el pronóstico del melanoma cutáneo depende, entre otros factores, de la existencia de diseminación linfática a ganglios. La biopsia del ganglio centinela busca identificar metástasis ganglionares subclínicas. Objetivo: el presente estudio tuvo por objetivo analizar la asociación entre la presencia de ganglio centinela positivo, identificado mediante rastreo con radioisótopo 99mTc-coloide de Renio, y el espesor de Breslow hallado en la lesión primaria a nivel cutáneo. Metodología: se analizaron 52 pacientes. Se realizó la búsqueda del ganglio centinela por el método de rastreo con radioisótopo 99mTc-coloide de Renio y posterior biopsia del mismo, en pacientes tratados en el Instituto Nacional de Cancerología de México, entre enero de 2015 a agosto de 2016, con diagnóstico de melanoma cutáneo y espesor de Breslow mayor o igual a 1mm o con menor a 1mm y otros criterios de riesgo como la ulceración. Aquellos con biopsia positiva fueron sometidos a linfadenectomía. Además, se recogieron las siguientes variables: sexo, edad, localización, tipo de melanoma, espesor de Breslow y ulceración. Resultados: la edad media de la muestra fue 57 ± 15 años. El 63,5% de los pacientes fue del sexo masculino. El tipo histológico más frecuente fue el melanoma de extensión superficial (69,2%). Se detectó positividad del ganglio centinela en 46,2% y 28,8% presentó Breslow >4,0 mm. Se encontró relación entre la presencia de ganglio centinela positivo y espesor de Breslow (p=0,007). Conclusiones: a medida que aumenta el espesor de Breslow, lo hace también el encuentro de metástasis en ganglio centinela. Se recomienda realizar estudios de casos y controles para evaluar el factor predictivo que puede llegar a tener el encontrar ganglio centinela positivo. ABSTRACT Introduction: It is known that the prognosis of cutaneous melanoma depends, among other factors, on the existence of lymphatic spread to lymph nodes. Sentinel node biopsy seeks to identify subclinical lymph node metastases. Objective: The present study aimed to analyze the association between the presence of positive sentinel lymph node, identified by Rhenium 99mTc-colloid radioisotope tracing, and the Breslow´s depth found in the primary lesion at the cutaneous level. Methodology: 52 patients were analyzed. The sentinel lymph node was searched by the rhenium 99mTc-colloid radioisotope and subsequent biopsy of it in patients treated at the Instituto Nacional de Cancerología of Mexico, between January 2015 and August 2016, with a diagnosis of cutaneous melanoma and Breslow's depth greater-than or equal to 1mm or less-than 1mm and other risk criteria such as ulceration. Those patients with positive biopsy underwent lymphadenectomy. In addition, the following variables were collected: sex, age, location of the lesion, type of melanoma, Breslow's depth, and ulceration. Results: Mean age of the sample was 57±15 years. 63.5% of the patients were male. The most frequent histological type was superficial spreading melanoma (69.2%). 46.2% had positive sentinel lymph node. 28.8% presented Breslow >4.0 mm. A relationship was found between the presence of positive sentinel lymph node and Breslow's depth (p=0.007). Conclusions: As Breslow's depths increases, so does the metastasis encounter in sentinel lymphs nodes. It is recommended to carry out case-control studies to evaluate the predictive factor that may result in finding a positive sentinel lymph node.

Background The mortality of cutaneous melanoma has not declined over the past 50 years. The only interventions that can reduce mortality are primary prevention and early diagnosis, and the dermoscopic evaluation is essential to achieve this. Dermoscopy identifies characteristics of melanoma that would go unnoticed to the naked eye. The aim of this paper is to report the most frequent dermoscopic findings in patients diagnosed with in situ and invasive melanoma. Material and methods An observational and retrospective study of contact dermoscopy was performed using LED Dermlite™ and camera Dermlite™ dermoscope. The findings evaluated were: asymmetry in two axes, association of colours, lack of pigment, irregular points, atypical network, pseudopods, blue veil, ulceration, and peri-lesional pink ring. These dermoscopic findings were compared with the histological diagnosis. Results The study included 65 patients with cutaneous melanoma; 10 in situ , and 55 invasive. The mean Breslow in invasive melanoma was 3 mm. Most patients (35) had localisation in extremities. In all patients, the most frequent dermoscopic finding was asymmetry in two axes, followed by association of two or more colours; in melanoma in situ , asymmetry was the most frequent, followed by atypical-irregular points. In invasive melanoma asymmetry in two axes, the association of two or more colours, and pseudopods, were the most frequent findings. Conclusion Asymmetry in two axes is the most common dermoscopic finding in in situ and invasive melanoma. The presence of two or more colours in a pigmented lesion should be suspected in an invasive melanoma.