Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA

There are no financial disclosures or conflicts of interest to disclose for Jeffrey M.

A pigmented lesion on the lower limb of an 80-year-old woman had been present for five years and had remained consistent in appearance until a pigmented nodule formed. Within three months, two further nodules developed close to the primary lesion. A 2.2-mm nodular melanoma with no ulceration and dermal mitosis (3 mm2) with a positive satellite nodule was discovered by punch biopsy of the original lesion and satellite nodule. Fluorodeoxyglucose (FDG) avid inguinal lymph node (LN) on preoperative positron emission tomography/computed tomography was consistent with melanoma on cytology. She received a broad local excision of the melanoma and satellite nodules as well as a left superficial inguinal LN dissection.

A 1.8-mm primary melanoma with 4/9 positive inguinal LNs was discovered by final pathology. She underwent adjuvant radiation, and soon after, two in-transit nodules were discovered. These nodules were removed in August 2015 and were consistent with melanoma. Her pembrolizumab treatment began in September 2015. She has remained healthy the entire time.

M.Jeffrey.satellite lesions in addition to a primary melanoma. Insights of Clinical and Medical Images 2022.