What is an excision of the collarbone

Just a mole? Hardly likely!

_ A 76-year-old man presented with a disturbing skin change below the right collarbone. A “mole” would have been at this point for years, but recently it had increased in size. Inspection with the naked eye revealed a pigment spot 2 × 3 cm in size, which had a central unpigmented portion with a moist surface. The periphery showed the typical polycyclic spread with blurred edges, which suggested a melanoma.

The following day, an outpatient spindle-shaped excision was made at a distance of 5 mm. Histopathology confirmed a superficial spreading melanoma, which consisted of alternately strongly pigmented epidermal cell nests. In the center there was a sharply demarcated, morphologically different nodule containing cells with a light-colored cytoplasm. The prognostically important tumor thickness was 3.9 mm.

The recommended re-excision with a distance of at least 2 cm from the scar and deep down to the fascia was easy to perform in view of the localization. This preparation was tumor-free. A sentinel lymph node was removed from the right axillary and examined; he was also tumor-free.

The guideline-based follow-up care - quarterly appointments with physical examination, lymph node ultrasound and measurement of the tumor marker S100 - did not reveal any abnormalities even one year after the operation.

Melanoma is a very aggressive tumor of the skin pigment cells. The incidence has increased to around 14 cases per 100,000 population in recent years. The most important reason for the increase is the changed leisure behavior, which is associated with increased UV exposure. Among the subtypes, superficial spreading melanoma has the most favorable prognosis because it metastasizes relatively late. The only causal therapy is early, complete surgical removal. In the case of noticeable pigment changes, no delay should therefore be allowed.

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  1. Schützenstrasse 8, D-14943, Luckenwalde, Germany

    Dr. med. Jens Iffländer

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Correspondence to Dr. med. Jens Iffländer.

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Iffländer, J. Just a mole? Hardly likely!. MMW - Advances in Medicine160, 7 (2018). https://doi.org/10.1007/s15006-018-1199-0

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