An 88‐year‐old white woman presented with a subcutaneous mass on the left lateral brow (Figure, A). She had been aware of this lesion for the past 8 years, but it had increased in size over the past 2 months, and was associated with erythema and a sensation of paraesthesia. Orbital ultrasound revealed a well defined subcutaneous hypervascular lesion with no invasion in the adjacent structures, but the appearances were non‐specific. She underwent excision biopsy (Figure, B). Histopathology (Figure, C; left: interlacing fascicles of malignant spindle shaped cells with background chronic inflammatory cell infiltrate [haematoxylin and eosin stain]; right, immunoperoxidase stain showing strong nuclear positivity for SOX10, a marker of malignant melanoma) revealed a malignant spindle cell melanoma with no perineural involvement. Wider excision was performed with adjunctive radiotherapy to the tumour bed. The post‐operative positron emission tomography (PET) and computed tomography scans were clear. At 6 months, the site was well healed with a good cosmetic result (Figure, D). Spindle cell melanoma is a rare subtype of malignant melanoma. This case highlights the importance of histopathological confirmation and follow‐up adjunctive therapies.1
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