Metastatic dedifferentiated malignant melanoma with spindle cell morphology

Malignant melanomas have an intrinsic ability to present in a variety of ways necessitating biopsies, immunohistological staining and next-generation sequencing for an accurate diagnosis. A dedifferentiated melanoma by virtue of its transformation from its typical morphohistological features represents a rare aggressive form with poor responses to immunotherapy and targeted therapy. Dedifferentiation along with metastasis may lead to changes in goals of care, with treatments shifting from curative intent towards palliation. Our patient, a man in his early 60s, presented with a slow growing skin lesion on the back over two decades along with a recently noticed right axillary mass. During our investigations, a rapid deterioration in the patient’s functional status necessitated hospitalisation and intensive care. We present this rare atypical rapid course to emphasise the value of diagnosis and palliation by a multidisciplinary team to improve quality of life for such patients.