Melanoma associated with subacute primitive fibrinolysis

• Published in: Journal of the European Academy of Dermatology and Venereology Vol. 19; no. 6; pp. 737 - 739
• Main Authors: Blaise, S, Rumeau‐Trividic, M, Le Brun, V, Bedane, C, Bonnetblanc, JM
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-11-2005
• Subjects: Blood Transfusion; Fatal Outcome; Fibrinolysis; Humans; Liver Neoplasms - secondary; Male; melanoma; Melanoma - secondary; Melanoma - surgery; Middle Aged; Reoperation; Skin Neoplasms - pathology; Skin Neoplasms - surgery
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2005.01273.x

Background  Surgery is the first treatment of a pigmented skin lesion when a melanoma is suspected. This excision is most of the time realized by the dermatologist as well as the second time surgery. Bleeding at the surgical site may have numerous aetiologies. Fibrinolysis is a rare but dramatic event.
Case report  We report a case with delayed bleeding after excision of a melanoma. The patient was re‐operated and a major haemorrhage followed so that a transfusion of blood and fresh frozen plasma was necessary. The biological investigations concluded to a subacute primitive fibrinolysis associated with the melanoma. The patient was first considered to have completely recovered when a blood‐borne liver metastasis diffusion rapidly occurred. The patient deceased within a few months from a hepatic encephalopathy with hepatic metastases.
Discussion  We find only a few published cases of melanoma with fibrinolysis. Its association with other abnormalities, like a partial factor XIII deficiency, made these abnormalities even more difficult to identify. The relation between the subacute fibrinolysis, the melanoma and the liver infiltrative metastasis is difficult to establish.