BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5474
  • Reminder of important clinical lesson

It is never too late: ultra-late recurrence of melanoma with distant metastases

  1. Deepak Kejariwal
  1. Department of Medicine, University Hospital of North Durham, Durham, UK
  1. Correspondence to Dr Dina Mansour, dmansour299{at}


The authors present the case of a 73-year-old lady presenting with weight loss, personality changes, transient confusion and visual loss, 38 years after initial surgical excision of a melanoma of the neck. CT and MRI of the brain showed cerebral metastases and positron emission tomography (PET)-CT showed an additional fludeoxyglucose avid lesion in the lung, which was biopsied. Histology confirmed metastatic malignant melanoma. She declined whole brain radiotherapy in favour of best supportive care and died 4 months after diagnosis. Life-long vigilance among patients with previous melanoma and awareness among physicians are necessary if late recurrences are to be recognised early, and outcomes improved. New imaging techniques including PET-CT may be helpful in diagnosing and staging melanoma recurrence. Treatment options for patients presenting with distant metastases are limited and the prognosis remains poor.


  • Competing interests None.

  • Patient consent Obtained.

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