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Unusual presentation of primary cutaneous melanoma of the forearm with epitrochlear and axillary lymphadenopathy
  1. Siok Yen Pow1,
  2. Melissa Teo2
  1. 1Department of General Surgery, Singapore General Hospital, Singapore
  2. 2Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
  1. Correspondence to Dr Melissa Teo, melissa.teo.c.c{at}


In patients with primary cutaneous melanomas of the distal upper limb, metastatic involvement of the epitrochlear lymph nodes is uncommon. It belongs to a particular category of nodal metastasis termed as interval or in-transit lymphadenopathies often encountered by tumour cells as they spread from the primary sites. We describe the case of a 41-year-old woman who presented with a right forearm melanoma that was metastatic to both the epitrochlear and axillary lymph nodes. She underwent wide excision of the primary lesion as well as epitrochlear and axillary nodal clearances in the same sitting. Although uncommon, It is prudent to search for the presence of sentinel lymph nodes in the epitrochlear region although uncommon, and where positive, a completion axillary clearance should be undertaken at the same time as the epitrochlear clearance. Failure to detect the presence of interval lymph nodes along the melanoma spread pathways may be a cause of tumour recurrence.

  • Surgical Oncology
  • Skin Cancer
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  • Contributors SYP collected and interpreted the data and wrote the manuscript including the discussion and implications of the collected data. MT designed the study concept and contributed to the discussion, provided conceptual advice and supervised as well as edited the manuscript. Both authors approved the final version of the manuscript to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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