Metastatic malignant melanoma: axillary lymphadenopathy and the ugly duckling sign

A 52-year-old woman presented to the breast clinic with a 6-week history of an enlarging and palpable, non-tender left axillary swelling. Fine needle aspiration from the left axillary lymph nodes revealed malignant melanoma; however, the referring team did not identify a primary cutaneous lesion on skin inspection. Screening mammogram and stereotactic biopsy also identified ductal carcinoma in situ of the right breast, treated by wider excision and radiotherapy, and left axillary node clearance identified 2 of 11 nodes as positive for melanoma.