High-risk melanoma with nodal involvement in a young woman


Background An 18-year-old female presented to her General Practitioner with a bleeding mole on her back. The mole had been present since childhood but had started to bleed in the past month. She was otherwise asymptomatic with no relevant previous medical history. Physical examination revealed a 1.5 cm × 1.7 cm pigmented lesion on the left aspect of the patient's upper back. There was no palpable lymphadenopathy.

Investigations Physical examination, excision biopsy, sentinel lymphnode biopsy, CT scan of chest, abdomen and pelvis.

Diagnosis Stage IIIB (T3bN2aM0) focally ulcerated, nodular malignant melanoma (Breslow depth 2.5 mm, Clark's level IV).

Management Wide re-excision, completion dissection of the left axillary lymph node, adjuvant high-dose interferon with maintenance interferon.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1

    Eggermont A et al. (2001) Cutaneous malignant melanoma. Oxford Textbook of Oncology, edn 2 Vol 1 Chapter 8.1, 1175–1211

    Google Scholar 

  2. 2

    Balch C et al. (2001) Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 19: 3635–3648

    CAS  Article  Google Scholar 

  3. 3

    Thomas J et al. (2004) Excision margins in high-risk malignant melanoma. N Engl J Med 350: 757–766

    CAS  Article  Google Scholar 

  4. 4

    Cascinelli N et al. (1998) Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomized trial. WHO Melanoma Programme. Lancet 351: 793–796

    CAS  Article  Google Scholar 

  5. 5

    Morton D et al. (2005) Sentinel node biopsy for early stage-melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 242: 302–311

    PubMed  PubMed Central  Google Scholar 

  6. 6

    Puleo C et al. (2005) Sentinel node biopsy for thin melanomas: which patients should be considered? Cancer Control 12: 230–235

    Article  Google Scholar 

  7. 7

    Reintgen D et al. (2004) National trials involving lymphatic mapping for melanoma: the Multicenter Selective Lymphadenectomy Trial, the Sunbelt Melanoma Trial, and the Florida Melanoma Trial. Semin Oncol 31: 363–373

    Article  Google Scholar 

  8. 8

    Kretschmer L et al. (2004) Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphadenectomy and early excision of their nodal disease. Eur J Cancer 40: 212–218

    CAS  Article  Google Scholar 

  9. 9

    Kirkwood JM et al. (1996) Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Co-operative Oncology Group trial EST 1684. J Clin Oncol 14: 7–17

    CAS  Article  Google Scholar 

  10. 10

    Kirkwood JM et al. (2000) High and low dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol 18: 2444–2458

    CAS  Article  Google Scholar 

  11. 11

    Kirkwood JM et al. (2001) High-dose interferon alfa-2b significantly prolongs relapse free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIb-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol 19: 2370–2380

    CAS  Article  Google Scholar 

  12. 12

    Kirkwood JM et al. (2004) A pooled analysis of eastern cooperative oncology group and intergroup trials of adjuvant high-dose interferon for melanoma. Clin Cancer Res 10: 1670–1677

    CAS  Article  Google Scholar 

  13. 13

    Gogas H et al. (2004) Tolerability of adjuvant high-dose interferon alfa-2b: 1 month versus 1 year: a Hellenic Cooperative Oncology Group study. Anticancer Res 24: 1947–1952

    CAS  PubMed  Google Scholar 

  14. 14

    Von Wussow P and Mohr P (2003) Adjuvant intermittent high dose interferon α-2b therapy in stage IIC/III malignant melanoma: a phase II study [abstract #2912]. Proc Am Soc Clin Oncol 22: 724

    Google Scholar 

  15. 15

    Demierre M et al. (2005) Vaccine therapy of melanoma: an update. Curr Canc Ther Rev 1: 115–125

    CAS  Article  Google Scholar 

  16. 16

    Atkins M et al. (2000) High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update. Cancer J Sci Am 6 (Suppl 1): S11–S14

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Omar Khan.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Khan, O., Middleton, M. High-risk melanoma with nodal involvement in a young woman. Nat Rev Clin Oncol 3, 517–521 (2006). https://doi.org/10.1038/ncponc0582

Download citation


Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing