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A historical case report concerned wide distribution of skin metastases.
Therefore, this paper sets out to provide 2 such modern cases occurring in a
developing community in Nigeria, especially as both were associated with
leprosy.
Keywords: Melanoma,
Metastases, Widespread, Skin, Leprosy, History
INTRODUCTION
Therefore, this paper seeks to a Nigerian ethnic group [4]. These
manifested because, as was predicted by a Birmingham (UK) group, the
establishment of a histopathology data pool encourages epidemiological analysis
[5]. Such a pool was established by the Government of the then Eastern Region
in 1970 after the Civil War with the author as the pioneer pathologist. The
pathology of the Igbos has been well published since then [6].
CASE REPORT
1.
NE, 60
year old man attended the Mile 4 Hospital, Abakaliki and was seen by Dr. MA
MacRae. He complained of many “lumps” appearing all over the body since 3
months. They started with one near the shoulder. He was a discharged leprosy
patient with chronic plantar ulcer. On examination, widespread, subcutaneous
nodules of varying sizes all over the body were seen, especially on the trunk.
They were not ulcerated but firm, some larger ones being tender. The 1.5 × 1.0
cm skin ellipse bore a dark nodule on section. On microscopy, the nodule was
seen to be due to malignant melanoma. Accordingly, melanomatosis was diagnosed.
As my Report stated, “It is well to biopsy the plantar ulcer which may reveal
the primary site.” However, there was no follow-up reported.
2.
UN, 60
year old female attended the Mater Hospital, Afikpo, under the care of Dr M.
Molloy. Multiple widespread nodules were found all over the body
subcutaneously. Some were umbilicated. The lesions had been present for 3
years, the spread being gradual. She was a discharged leprosy patient with foot
ulcer. The specimen was a 2.5 cm partly incised ellipse with a blackish nodule.
Microscopy confirmed the diagnosis of metastasing malignant melanoma.
DISCUSSION
A remarkable feature is that both
patients attended two Missionary Hospitals run by foreigners. This emphasizes
the role of foreign help in running the Health Services of a developing
community.
Another point of interest is the use
of a central laboratory by distant hospital. Long ago, there was debate as to
whether this was fruitful in the UK [7]. Actually, local experience counters
this view [8].
The pathogenesis of generalized
melanosis was explored in 1981 but the emphasis was on melanuria [9].
Consequently, future studies should relate to the association with those
previously suffering from leprosy.
Alone case of squamous carcinoma
arising in a leprous neurotropic ulcer
with review of the literature is on record
1.
Mackenzie J (1891) Melanotic sarcoma, very widely
disseminated. Trans Path Soc Lond 42: 321-329.
2.
Ariel IM (1975) Disseminated melanoma with unique
unilateral distribution. Cancer36Cancer 36: 2143-2146.
3.
Sarkisian JS (1975) Metastatic melanoma in two unusual
sites. U.S. Navy Med 65: 8-9.
4.
Basden GT (1966) Niger Ibos. Cass, London.
5.
Macartney JC, Rollaston TP, Codling BW (1980) Use of a
histopathology data pool for epidemiological analysis. J Clin Pathol 33:
351-353.
6.
Onuigbo WIB (1980) Studies on the geographical pathology
of the Igbos of Nigeria. Glasgow University.
7.
Lilleyman J (2002) From the president. Bull Roy Coll
Pathol 117: 2-3.
8.
Onuigbo WIB, Onuigbo WIB, Mbanaso AU (2005) Urban
histopathology service for a remote Nigerian hospital. Bull Roy Coll Pathol
132: 32-34.
9.
Eide J (1981) Pathogenesis of generalized melanosis with
melanuria and melanoptysis secondary to malignant melanoma. Histopathology 5:
285-294.
10.
Troy JL, Grossman ME, Walther RR (1980) Squamous-cell
carcinoma arising in a leprous neurotrophic ulcer: Report of a case. J Dermatol
Surg Oncol 6: 650-661.
11.
Onuigbo WIB, Njeze GE (2014) Plantar squamous cell
carcinoma in a developing country. Intl Interdisciplin Res J 4: 2-16.
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