A woman in her 40s with a medical history of multiple sclerosis consulted for the sudden development of 2 adjacent nodules on the left arm. An excision with 1-cm margins of the left arm demonstrated desmoplastic melanoma with a Breslow thickness of 1 mm, and a left axillary sentinel lymph node biopsy (SLNB) had been performed 3 weeks before under general anesthesia. The patient was also being treated with subcutaneous interferon beta 1a for the multiple sclerosis. Physical examination revealed 2 indurated and mobile subcutaneous nodules on the anterior surface of the arm 5 cm distal to the surgical scar, the larger of them measuring 15 mm in diameter (Figure, A) and the smaller of them measuring 4 mm. When the arm was abducted to 90°, the patient denied pain but described a subtle tightness sensation on the arm. An excisional biopsy from the larger lesion was performed (Figure, B-D).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Alejandra Sandoval-Clavijo, MD, MSc, Department of Dermatology, Hospital Clinic, Carrer Villaroel 170, 08036, Barcelona, Spain (email@example.com).
Published Online: January 26, 2022. doi:10.1001/jamadermatol.2021.5689
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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