Primary malignant melanoma of bone (clear cell sarcoma): A case report

Document Type : Case Report/Series


1 Department of Orthopedic, Faculty of Medicine, Islamic Azad University, Tehran, Iran.

2 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran.

3 Hematology and Oncology and Stem Cell Transplantation Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

4 hematology oncology and stem cell transplantation department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran


Melanoma is a malignant tumor that predominantly arises in the skin. In rare cases, however, it can manifest in the bone too. In this paper, a primary malignant melanoma of the lesser trochanter of the right femur is described.
In this case, the subject was a 19-year-old woman presenting with pelvic floor pain that lasted for 3 weeks.
Magnetic resonance imaging (MDR) showed that T2MRI has bone melanoma soft tissue edema that sustained to malignant melanoma.
Immunohistochemistry report revealed that tumoral cells were positive for HMB45, S100, which is suggestive of melanoma diagnosis.
The patient was admitted and underwent CNB. Since the result was negative, the patient received a wide local excision from the right lesser trochanter.
The histopathological examination of biopsy revealed fibro sclerotic tissue affected by malignant melanoma.
The patient was then referred to an oncologist for postoperative adjust chemotherapy and target therapy.
Keywords: a case report- melanoma- clear cell sarcoma


 1.McJunkin JL, Wiet RJ. Primary melanoma of the
petrous temporal bone. ENT Journal. 2015;94(7):E19-
20. 4.
2.Singh VA, Lim CY, Yan HC, Rahman NA. Primary
Melanoma of the Third Metatarsal. J Foot Ankle Surg.
2017Nov-Dec;56(6):1292-1297. doi:
3.Costache M, Stoica A, Contolenco A, et al. Metastatic
Melanoma in the Femur - Case Report with Review of
Literature: a Pathologist's Point of View. Maedica
(Bucur). 2014;9(1):62-67.
4.Yokoyama R, Mukai K, Hirota T, Beppu Y, Fukuma
H. Primary malignant melanoma (clear cell sarcoma) of
bone: report of a case arising in the ulna. Cancer. 1996
5.Taniguchi T, Kawaguchi K, Fukui T, Nishimura M,
Yokoi K. Primary malignant melanoma of the thymus:
report of a case. Surg Today. 2015 Sep;45(9):1187-9.
doi: 10.1007/s00595-014-0998-x. Epub 2014 Jul 29.
6.Fon GT, Wong WS, Gold RH, Kaiser LR. Skeletal
metastases of melanoma: radiographic, scintigraphic,
and clinical review. AJR Am J Roentgenol. 1981
Jul;137(1):103-8. doi: 10.2214/ajr.137.1.103.
7.Chung EB, Enzinger FM. Malignant melanoma of soft
parts. A reassessment of clear cell sarcoma. Am J Surg
Pathol. 1983 Jul;7(5):405-13. doi: 10.1097/00000478-
8.Bostel T, Förster R, Schlampp I, Wolf R, Serras AF,
Mayer A, Bruckner T, Welzel T, Schmidberger H,
Debus J, Rief H. Stability, prognostic factors and
survival of spinal bone metastases in malignant
melanoma patients after palliative radiotherapy. Tumori.
2016 Mar-Apr;102(2):156-61. doi: 10.5301/tj.5000382.
Epub 2015 Jul 8.
9.Sekita A, Matsugaki A, Ishimoto T, Nakano T.
Synchronous disruption of anisotropic arrangement of
the osteocyte network and collagen/apatite in melanoma
bone metastasis. J Struct Biol. 2017 Mar;197(3):260-
270. doi: 10.1016/j.jsb.2016.12.003. Epub 2016 Dec 16.
10.Katz KA, Jonasch E, Hodi FS, Soiffer R, Kwitkiwski
K, Sober AJ, Haluska FG. Melanoma of unknown
primary: experience at Massachusetts General Hospital
and Dana-Farber Cancer Institute. Melanoma Res. 2005
Feb;15(1):77-82. doi: 10.1097/00008390-200502000-
11.Rigel DS, Friedman RJ, Kopf AW. The incidence of
malignant melanoma in the United States: issues as we
approach the 21st century. J Am Acad Dermatol. 1996
May;34(5 Pt 1):839-47. doi: 10.1016/s0190-
12.Savage RA, Lucas FV, Hoffman GC. Melanoma in
marrow aspirates. Am J Clin Pathol. 1983
Feb;79(2):268-9. doi: 10.1093/ajcp/79.2.268.
13.Baab GH, McBride CM. Malignant melanoma: the
patient with an unknown site of primary origin. Arch
Surg.1975Aug;110(8):896-900. doi:
14.Chang P, Knapper WH. Metastatic melanoma of
unknown primary. Cancer. 1982 Mar 15;49(6):1106-11.

Vahideh M et al.
Razavi Int J Med. 2022; 10(2):e1233. 101
15.Smith JL Jr, Stehlin JS Jr. Spontaneous regression of
primary malignant melanomas with regional metastases.
Cancer. 1965 Nov;18(11):1399-415. doi: 10.1002/1097-
16.Yaziji H, Gown AM. Immunohistochemical markers
of melanocytic tumors. Int J Surg Pathol. 2003
Jan;11(1):11-5. doi: 10.1177/106689690301100103.
17.Jain D, Singh T, Kumar N, Daga MK. Metastatic
malignant melanoma in bone marrow with occult
primary site--a case report with review of literature.
Diagn Pathol. 2007 Oct 2;2:38. doi: 10.1186/1746-1596-
OF 21 CASES. Cancer. 1965 Sep;18:1163-74. doi:
19.Weiss SW, Langloss JM, Enzinger FM. Value of S-
100 protein in the diagnosis of soft tissue tumors with
particular reference to benign and malignant Schwann
cell tumors. Lab Invest. 1983 Sep;49(3):299-308
20.Lucas DR, Nascimento AG, Sim FH. Clear cell
sarcoma of soft tissues. Mayo Clinic experience with 35
cases. Am J Surg Pathol. 1992 Dec;16(12):1197-204.
doi: 10.1097/00000478-199212000-00006.
21.Urmacher C. Unusual stromal patterns in truly
recurrent and satellite metastatic lesions of malignant
melanoma. Am J Dermatopathol. 1984 Summer;6
22.Brekke MK, Northcote K, Temple WE. Clear cell
sarcoma in the first metatarsal. An unusual case. J Am
Podiatr Med Assoc. 1998 Sep;88(9):457-61. doi:
23.Kubota, Y., Tanaka, K., Hisaoka, M. et al. Primary
clear cell sarcoma of the femur: a unique case with RTPCR and direct sequencing confirmation of
EWSR1/ATF1 fusion gene. BMC Musculoskelet Disord
2021; 22(99). doi: 10.1186/s12891-021-03969-4