Abstract
This article is a case report of a 78-year old Japanese woman with a history of malignant melanoma resected from her right 2nd toe followed by an ilioinguinal lymph node dissection in 1980. The lymph node dissection, however, was not quite successful, because numerous nodes were proved metastatic tumors. The histological specimen obtained from the primary lesion was found to be acral lentiginous melanoma, Clark's level III, 0.8mm in thickness, pT2N2M1a, stage IV. She underwent combination chemotherapy using DTIC, nitrosourea and vincristine (DAV) for 5 years and vaccination with BCG (Japanese lnstitute for BCG, Tokyo) for 7 years.
Although metastatic tumors in paraaortic lymphnodes were not completely dissected, no evidence of distant metastases including recurrence of regional lymph node metastasis was noted prior to the appearance of intransit metastases in her right leg 13 years after the initial surgical procedures. In addition to the excision of intransit metastases, she was treated with DAV and intracutaneous injection of interferon-β. Late recurrence (i.e. 10 or more years after definitive surgery) is not unusual in malignant melanoma, but is rare in an advanced stage of melanoma such as our case.
