Faculty of Medicine
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Item type:Publication, A challenging "silent depth" clinical scenario in North Macedonia: Unmasking a rare case of amelanotic melanoma with trapezius muscle invasion and metastatic disease(Centre for Evaluation in Education and Science (CEON/CEES), 2025); ; Aleksovski, DarkoIntroduction: Amelanotic melanoma is a subtype of melanoma that exhibits little or no pigment on visual or histological examination. Approximately 1-8% of all melanomas are amelanotic. It can mimic various benign or malignant melanocytic and non-melanocytic skin tumors, thereby presenting a significant diagnostic challenge. Primary amelanotic melanoma with muscle involvement is an extremely rare entity. A review of the literature revealed no series or case reports. Case Report: We present the case of a 62-yearold female patient with primary amelanotic melanoma infiltrating the trapezius muscle. The tumor was excised together with a clinically positive lymph node on the right side of the neck. Computed tomography (CT) angiography of the lungs, abdomen, and pelvis demonstrated bilateral diffuse nodular changes, a mediastinal pretracheal lymph node, and multiple diffuse liver lesions, consistent with secondary deposits. Molecular pathology revealed positivity for the BRAF V600E2/K/R/D mutation, and the patient began firstline targeted therapy with BRAF/MEK inhibition in accordance with protocols for BRAF-positive metastatic melanoma. Three months later, a follow-up CT scan demonstrated complete remission of the previously observed metastatic changes. Conclusion: Primary amelanotic melanoma with muscle involvement is exceptionally rare, with no published series or case reports identified. This case highlights the importance of early detection and treatment in suspected melanoma and underscores the need to consider melanoma in all clinically unclear cases. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Toxic Epidermal Necrolysis: Case Report and Review(Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia, 2024-03-12); ; ; ; Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions primarily caused by drugs. Characterized by fever, prodromal symptoms, and extensive epidermal sloughing with mucous membrane involvement (>90%), they are collectively termed epidermal necrolysis and are considered a disease continuum.CASE PRESENTATION: A65-year-old man presented with widespread erythema and distinctive target-like lesions, accompanied by ruptured flaccid vesicles on the extremities. Following a 4-week carbamazepine treatment for a previous cerebrovascular insult, hematological analysis revealed abnormalities. Amultidisciplinary team, including a neurologist, endocrinologist, and ophthalmologist, prescribed a 3-day course of intravenous immunoglobulin at 0.5g/kg and an initial dose of 300mg prednisolone for 3days, supported by additional therapy. Discharged after 3weeks, the rash completely resolved within 2months. CONCLUSION: TEN, a severe mucocutaneous condition with a 30% mortality rate, often results from drug exposure. Swift identification of the causative drug is crucial for optimal outcomes. Treatment primarily includes discontinuing the offending drug and offering supportive care for mucocutaneous lesions. Amultidisciplinary approach is vital based on organ system involvement. The effectiveness of pharmacological treatments, such as intravenous immunoglobulin and corticosteroids, is continually under evaluation.