Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
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David Rain
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Silent Spread: Metastatic Melanoma in an Elderly Patient with Cognitive Impairment

Tajala Aman MD, Chelsey Arvin DO, Folake Ishola MD M.Sc*, Muhammad Ulusyar Khan MBBS, Lannie Cation MD FACP

Department of Internal Medicine, Ascension St. Vincent Hospital Indianapolis, Indiana, USA

Abstract: Malignant melanoma is an aggressive malignancy with a strong propensity for distant metastasis. Although melanoma represents a smaller proportion of total skin cancer diagnoses, it accounts for most skin cancer related deaths in the United States. Cutaneous metastases can be recognized as a manifestation of advanced disease. We report the case of a 75-year-old man with significant comorbidities who presented after recurrent falls and was found to have diffuse subcutaneous nodules. Imaging demonstrated extensive metastatic involvement of multiple organ systems and biopsy confirmed metastatic melanoma. Remote history of a skin lesion excision more than a decade earlier without documented diagnosis or surveillance was later identified. This case underscores the diagnostic significance of cutaneous metastases and the importance of long term follow-up after lesion excisions.

Keywords: Malignant melanoma, Metastatic melanoma, Cutaneous metastases, Multiorgan metastases, Subcutaneous nodules, Skin cancer, Cancer surveillance, Cognitive impairment

Received May 15, 2026; Revised June 17, 2026; Accepted June 23, 2026

Citation: Tajala Aman MD, Chelsey Arvin DO, Folake Ishola MD M.Sc, Muhammad Ulusyar Khan MBBS, Lannie Cation MD FACP, Silent Spread: Metastatic Melanoma in an Elderly Patient with Cognitive Impairment. American Journal of Medical Case Reports, 14 (4). 45-47. January 2026. doi:10.12691/ajmcr-14-4-1

1. Introduction

Malignant melanoma comprises approximately 1% of all skin cancers but is responsible for most skin cancer related deaths due to its high metastatic potential [1,2]. In the United States, melanoma incidence continues to rise, particularly among older adults and fair-skinned populations, with more than 50,000 invasive cases diagnosed annually [2]. While early detection and surgical excision are often curative, melanoma demonstrates an unpredictable clinical course with the capacity for late recurrence and distant dissemination. Melanoma typically metastasizes to the liver, lungs, bone, brain, and subcutaneous tissue. It is the leading cause of cutaneous metastases in men (32.3%) and second in women (12.0%) after breast cancer (70.7%) [4,5].

Cutaneous metastases are an important but often underrecognized manifestation of systemic disease and may present as firm dermal or subcutaneous nodules with minimal overlying skin changes [3]. In some patients, these lesions represent the first or only clinical sign of melanoma recurrence, emphasizing the need for careful physical examination and thorough dermatologic history [6]. Delayed diagnosis is particularly concerning in vulnerable populations, including patients with neurocognitive or psychiatric disorders, in whom symptoms may go unreported.

2. Case Presentation

A 75-year-old man with a medical history significant for schizoaffective disorder, bipolar disorder, and dementia was transferred from a memory care facility for evaluation following a fall. Due to worsening memory from dementia, the patient was unable to provide a reliable history. Collateral information obtained from family members revealed that the patient had undergone excision of a skin lesion approximately 13 years ago. No pathology reports, formal diagnosis, or subsequent dermatologic surveillance were available.

On physical examination, the patient was hemodynamically stable. Dermatologic evaluation revealed numerous firm, non-tender, 1-cm subcutaneous nodules diffusely distributed across the chest and abdomen. The overlying skin was grossly intact, however, some nodules demonstrated pigmentary changes as noted in Figure 1. The patient was oriented to self only, which was consistent with his baseline. There were no other focal neurologic deficits.

CT imaging of the chest, abdomen, and pelvis demonstrated widespread metastatic disease involving the mediastinum, lungs, liver, adrenal glands, retroperitoneum, osseous structures, and subcutaneous tissues as noted in Figure 2 and Figure 3. MRI of the brain did not show evidence of intracranial metastases. Excisional biopsy of a subcutaneous nodule on the chest was performed, and histopathologic examination confirmed metastatic malignant melanoma.

The patient’s family ultimately decided to return him to his original facility and pursue outpatient oncology follow-up. The patient subsequently passed away approximately one month after discharge from the hospital.

Figure 1. Diffuse subcutaneous nodules across the chest and abdomen

Figure 2. CT chest imaging showing widespread metastatic disease

Figure 3. Coronal contrast enhanced CT Abdomen/Pelvis showing widespread metastatic disease

3. Discussion

Malignant melanoma is distinguished from other cutaneous malignancies by its aggressive biologic behavior and propensity for widespread metastasis. Although non-melanoma skin cancers are far more prevalent, melanoma accounts for the majority of skin cancer related mortality, reflecting disproportionate lethality [1,2]. This aggressive biology necessitates heightened clinical suspicion when evaluating new or unexplained cutaneous findings, particularly in patients with known or suspected melanoma risk factors. Melanoma skin metastases may precede the detection of visceral disease and, in some cases, constitute the first or only clinical sign of melanoma recurrence [6]. Therefore, recognition of cutaneous metastases plays a critical role in staging, prognostication, and therapeutic decision making.

The timing of melanoma recurrence is highly variable. While many recurrences occur within the first five years following diagnosis, late recurrence after prolonged disease-free intervals has been well documented [7,8]. This supports the importance of long-term surveillance and careful dermatologic history, particularly when prior pathology records are unavailable. Additionally, the extent of metastatic burden at diagnosis remains a critical prognostic factor. Data demonstrates that survival declines significantly once distant metastases are present, particularly with multi-organ involvement [9]. In our patient case, the widespread distribution of metastatic disease at initial recognition likely reflects delayed detection rather than rapid progression, emphasizing the consequences of missed early recurrence.

Therapeutic advances have significantly altered the prognosis of metastatic melanoma. Immune checkpoint inhibitors targeting PD-1 and CTLA-4 pathways have produced durable responses and improved long-term survival in a subset of patients with advanced disease [10]. In a long-term follow up of patients treated with combination nivolumab and ipilimumab, nearly half achieved sustained survival at five years, representing an improvement when compared with previous outcomes [10]. Despite these advances, early detection remains essential, especially with confounding factors in vulnerable populations. Communication barriers, neurocognitive comorbidities, and limited access to preventive care are a few factors that may obscure early signs of disease progression. This case highlights the importance of thorough physical examination and heightened clinical awareness, which can assist in detection of advanced malignancy.

4. Conclusion

This case illustrates the aggressive and unpredictable metastatic behavior of malignant melanoma, including the potential for widespread dissemination many years after the initial lesion excision. Cutaneous metastases may serve as a sentinel marker of systemic disease and warrant prompt diagnostic evaluation. Long-term dermatologic surveillance and careful attention to history and physical examination are essential components of melanoma management, particularly in patients with neurocognitive comorbidities. Early recognition of recurrence may allow timely initiation of systemic therapy and improve clinical outcomes.

References

[1]   | American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society; 2024.
[2]   | Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2023). Cancer statistics, 2023. CA: A Cancer Journal for Clinicians, 73(1), 17–48.
[3]   | Di Raimondo, C., Lozzi, F., Di Domenico, P. P., et al. (2023). The diagnosis and management of cutaneous metastases from melanoma. International Journal of Molecular Sciences, 24(19), Article 14535. MDPI.
[4]   | Tas F, Erturk K. Metastatic behavior in melanoma: Timing, pattern, survival, and influencing factors. J Oncol. 2020; 2020: 1–9.
[5]   | Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol. 1993; 29(2 Pt 1): 228–236.
[6]   | Gershenwald, J. E., Scolyer, R. A., Hess, K. R., et al. (2017). Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition. CA: A Cancer Journal for Clinicians, 67(6), 472–492.
[7]   | Faries, M. B., Steen, S., Ye, X., et al. (2013). Late recurrence in melanoma: Clinical implications of lost dormancy. Journal of the American College of Surgeons, 217(1), 27–34.
[8]   | Crowley, N. J., & Seigler, H. F. (1990). Late recurrence of malignant melanoma: Analysis of 168 patients. Annals of Surgery, 212(2), 173–177.
[9]   | Balch, C. M., Gershenwald, J. E., Soong, S. J., et al. (2009). Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. Journal of Clinical Oncology, 27(36), 6199–6206.
[10]   | Larkin, J., Chiarion-Sileni, V., Gonzalez, R., et al. (2019). Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. New England Journal of Medicine, 381(16), 1535–1546.