INTRODUCTION
Among the major subtypes of melanoma, nodular melanoma is associated with the poorest prognosis.1 Nodular melanoma can be further subdivided into distinct variants, among which the polypoid (pedunculated) tumor has the poorest 5-year survival rate.1,2 Polypoid melanomas are characterized by an aggressive vertical growth phase and have been associated with early metastases through invasion of blood and lymphatic vessels at the tumor’s periphery.3 Clinically, the polypoid variant has a cauliflower-shaped appearance, with the bulk of the lesion located above the epidermis.1 Compared to other variants of nodular melanoma, polypoid melanoma is associated with younger age at presentation, increased thickness, more frequent ulceration, and higher probability of occult metastasis.1
Although surgical excision is the cornerstone of melanoma management, treatment of polypoid melanoma is complicated by several negative prognostic factors, including early metastasis.4 Nivolumab, an anti-programmed-death-1 (PD-1) antibody, was approved for the treatment of unresectable or metastatic melanoma in 2014, but its role in the treatment of polypoid melanoma with metastasis is unclear.5,6 We report the successful treatment of a rapidly developing red nodular polypoid melanoma with metastasis using surgery followed by nivolumab in a SARS-CoV-2-positive patient who delayed seeking care due to the COVID-19 pandemic.
Although surgical excision is the cornerstone of melanoma management, treatment of polypoid melanoma is complicated by several negative prognostic factors, including early metastasis.4 Nivolumab, an anti-programmed-death-1 (PD-1) antibody, was approved for the treatment of unresectable or metastatic melanoma in 2014, but its role in the treatment of polypoid melanoma with metastasis is unclear.5,6 We report the successful treatment of a rapidly developing red nodular polypoid melanoma with metastasis using surgery followed by nivolumab in a SARS-CoV-2-positive patient who delayed seeking care due to the COVID-19 pandemic.
CASE
We report the case of a 74-year-old man with rapid development of a forearm polypoid melanoma and metastasis concomitant with SARS-CoV-2 infection. An asymptomatic flat “sun spot†on the left forearm was noted by the patient approximately 6 months before diagnosis. It developed into an elevated 3.5 cm x 2.5 cm reddish skin nodule in the two months following SARS-CoV-2 infection. The patient had positive SARS-CoV-2 virus nasopharyngeal swabs and antibodies, in addition to multiple comorbidities including chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, and atrial fibrillation. The patient delayed seeking care for the forearm tumor due to COVID-19, despite noticing the fast enlargement of the lesion into a large, bleeding nodule (Figure 1).
