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<p>Metastatic malignant melanoma with unknown primary (MUP) in the upper aerodigestive tract is rare, often presenting diagnostic challenges due to nonspecific clinical and radiological findings.&#xa0;A 53-year-old man presented with a 4-month history of left-sided neck swelling, initially diagnosed as a paraganglioma based on contrast-enhanced computed tomography (CECT) showing a hyperenhancing lesion in the left carotid space. Surgical excision via Crile’s upper neck incision revealed a 4&#xa0;cm lesion, histologically confirmed as metastatic malignant melanoma in a cervical lymph node (IHC: HMB-45 4+, MELAN-A&#xa0;+, SOX-10 2+). Comprehensive examinations and postoperative PET-CT failed to identify a primary site, staging the disease as T0N1aM0 (AJCC 8th).&#xa0;The patient received adjuvant thalidomide (400&#xa0;mg daily) for suspected residual disease or inflammation that was noted on PET-CT. A follow-up PET-CT at 8 months showed no metabolically active disease, and the patient remains disease-free 10 years post-diagnosis.&#xa0;This case highlights the diagnostic complexity of cervical MUP, initially misdiagnosed as a paraganglioma, and underscores the efficacy of combining surgical resection with adjuvant thalidomide therapy. Thalidomide’s antiangiogenic and immunomodulatory effects likely contributed to the complete response and long-term survival. Accurate histopathological diagnosis, thorough primary site evaluation, and tailored adjuvant therapy are critical for optimizing outcomes in MUP, particularly in rare presentations involving cervical lymph nodes.</p>

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Misdiagnosis to Cure: Surgery and Thalidomide’s Role in Cervical Metastatic Malignant Melanoma with Long-Term Survival

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Shweta Kanaujia,
  • Vijay Chigurupati,
  • Madhumita Tripathi,
  • Manoj Pandey

摘要

Metastatic malignant melanoma with unknown primary (MUP) in the upper aerodigestive tract is rare, often presenting diagnostic challenges due to nonspecific clinical and radiological findings. A 53-year-old man presented with a 4-month history of left-sided neck swelling, initially diagnosed as a paraganglioma based on contrast-enhanced computed tomography (CECT) showing a hyperenhancing lesion in the left carotid space. Surgical excision via Crile’s upper neck incision revealed a 4 cm lesion, histologically confirmed as metastatic malignant melanoma in a cervical lymph node (IHC: HMB-45 4+, MELAN-A +, SOX-10 2+). Comprehensive examinations and postoperative PET-CT failed to identify a primary site, staging the disease as T0N1aM0 (AJCC 8th). The patient received adjuvant thalidomide (400 mg daily) for suspected residual disease or inflammation that was noted on PET-CT. A follow-up PET-CT at 8 months showed no metabolically active disease, and the patient remains disease-free 10 years post-diagnosis. This case highlights the diagnostic complexity of cervical MUP, initially misdiagnosed as a paraganglioma, and underscores the efficacy of combining surgical resection with adjuvant thalidomide therapy. Thalidomide’s antiangiogenic and immunomodulatory effects likely contributed to the complete response and long-term survival. Accurate histopathological diagnosis, thorough primary site evaluation, and tailored adjuvant therapy are critical for optimizing outcomes in MUP, particularly in rare presentations involving cervical lymph nodes.