RAPIDLY PROGRESSIVE METASTATIC MALIGNANT-MELANOMA IN AN HIV PATIENT WITH SEVERE IMMUNOSUPPRESSION AND ATYPICAL NEVUS SYNDROME

The case of a rapidly progressive, metastatic, malignant melanoma in an otherwise asymptomatic HIV male patient also presenting atypical nevus syndrome is described. The primary tumour developed on the left upper arm presented Breslow's thickness measuring 5.6 mm and Clark's level V. When the primary tumour was removed HIV antibodies were detected and immunological investigations revealed 220 CD4+ lymphocytes and a CD4+/CD8+ lymphocyte ratio of 0.2, but until that time no opportunistic infections or any other symptoms indicating HIV infection had occurred. Four months later the patient showed rapid metastatic spread df his melanoma starting from the left axillary region where lymph node dissection had been performed. X-ray treatment and chemotherapy with vindesine plus beta-interferon did not have any beneficial effect. Six weeks later the patient died owing to diffuse metastatic involvement. A review of the literature revealed some evidence for Increased melanoma risk in immunosuppressed individuals.