MANAGEMENT OF HIDDEN CUTANEOUS MELANOMA OF THE UMBILICUS

Objectives:

Background:
Melanoma is currently the fifth most common cancer in the United States (US) and most often develop on areas that have increased sun exposure, such as the arms, legs, back or face. Limited literature is available regarding the management of tumors originating in the umbilicus. By evaluating uncommon areas such as the umbilicus, earlier detection and possible intervention can be provided.

Methods:
We present a rare case of a 33-year-old female with a primary cutaneous melanoma of the umbilicus successfully treated with wide local excision (WLE) and sentinel lymph node biopsy (SLNB).

Case description:
The patient is a 33-year-old obese Caucasian female who described a pre-existing, pigmented, umbilical lesion for four years. She initially presented to dermatology for a full skin exam where all areas were noted to be normal except the umbilicus. The umbilical lesion appeared as a brown papule located on the lateral left umbilicus. A shave biopsy of the lesion was performed which demonstrated invasive superficial spreading malignant melanoma with a maximum Breslow’s depth of 1.0 millimeter (mm) and extended into Clark’s level IV. Mitoses were less than 1 per square mm and there were no ulcerations or regressions. There was extension to the peripheral resection margin but the deep margin was free of involvement. She was then referred for excision of the lesion with possible removal of the umbilicus as well as a sentinel lymph node biopsy (SLNB). Intraoperatively, she was found to have sentinel lymph node drainage to bilateral inguinal nodal basins and bilateral SLNB was performed. Attention was then directed to the umbilical lesion. A 2 cm margin was used and the umbilical stalk was resected, including the underlying peritoneum. A complex wound closure was necessary for closure of the defect. Final pathology was negative for any residual disease and sentinel lymph nodes were negative. She has been seen back in clinic and is doing well without evidence of recurrence at this time.

Discussion:
Cutaneous melanoma infrequently presents in non-sun-exposed areas. This case highlights the importance of a thorough whole-body dermatologic exam. By evaluating uncommon areas such as the umbilicus, earlier detection and possible intervention can be provided. In our specific case, melanoma of the umbilicus was successfully managed solely with wide local excision and SLNB. We advocate for increased education on the importance of complete examination to all providers with a special emphasis on those that regularly screen for cutaneous malignancies.

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