Metastatic acral melanoma with retroperitoneal and liver metastases: Diagnostic challenges and therapeutic dilemmas in a resource-limited clinical setting of district Swat, Pakistan

Authors

  • Sarab Jeet Singh Khyber Teaching Hospital, Peshawar
  • Charan Jeet Arora St Marys Skin Cancer Clinic and Medical Centre, NSW, Sydney, Australia
  • Asif Riaz Khan Life Care Hospital and Research Institute, Peshawar
  • James Mitchell South Eastern Sydney Local Health District, NSW, Australia
  • Irfanullah Irfanullah Khyber Teaching Hospital, Peshawar
  • Parmeet Kour DHQ Hospital, Abbotabad

DOI:

https://doi.org/10.66344/jpad.v36i1.3200

Keywords:

Acral melanoma, M1c, ipilimumab, resource-limited setting, Pakistan

Abstract

Acral melanoma is a rare subtype of cutaneous melanoma that often presents late in resource-limited settings. We report a 67-year-old woman from District Swat, Pakistan, with a 5-year history of a neglected pigmented plantar lesion who presented with jaundice and weight loss. CT imaging showed a large para-aortic retroperitoneal mass causing hydronephrosis and periampullary compression with biliary dilatation, along with liver metastases. Trucut biopsy revealed metastatic melanoma (S100+, HMB-45+, SOX10+). Molecular testing for BRAF V600 mutation was recommended but not performed due to unaffordability. Nivolumab monotherapy (anti–programmed cell death protein 1 [anti–PD-1]) was started, as dual immune checkpoint blockade was unaffordable, and a ureteric stent was placed. The patient was subsequently lost to follow-up. This case highlights diagnostic complexity and therapeutic inequities in metastatic acral melanoma in a resource-limited setting.

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Published

2026-03-31

How to Cite

1.
Singh SJ, Arora CJ, Khan AR, Mitchell J, Irfanullah I, Kour P. Metastatic acral melanoma with retroperitoneal and liver metastases: Diagnostic challenges and therapeutic dilemmas in a resource-limited clinical setting of district Swat, Pakistan. J Pak Assoc Dermatol [Internet]. 2026Mar.31 [cited 2026Mar.31];36(1):132-5. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/3200

Issue

Vol. 36 No. 1 (2026): January-March

Section

Case Reports

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