Case report Melanoma in bitumen burn 
Acral melarwma after a bitumen burn 
R. Peila, A. Poletti, E. Clonfero and C. Veller Fomasa 
SUMMARY 
A case of acral melanoma developed in a 59-year-old man; it was diagnosed 45 days after a bitumen 
burn had been reported. The relationship between the bitumen burn and the development of the malignant 
melanoma is discussed. 
Introduction 
A wide variety of physical and chemical agents and 
various forms of trauma are considered possible risk 
factors for malignant melanoma (MM). In particular, 
there are some <lata consistent with a relationship bet-
ween burns and the development of MM (1, 2). In these 
reports, the interval between bums and the clinical diag-
nosis of MM was extremely variable (from a few weeks 
to several years) (2- 4). We report a case of MM which 
developed a few weeks after a bitumen burn. 
Case report 
A 59-year-old man presented with a history of 
bitumen burn on his right sole about 45 days earlier. 
The man had been carrying asphalt bitumen for about 
30 years. Physical examination revealed an ulcerated 
plaque approximatively 4 cm in its greatest diameter 
on the plantar surface in of the right heel (Figure 1). 
This ulcerative lesion was deep red and with heaped-
up borders. The surface was wet and spongy. Two pig-
mented spots, about 2 mm wide, were present within 
the lesional area. The patient has been suffering from a 
severe burn in at the site of the lesion. A careful history 
failed to demonstrate the presence of a previous pig-
mented lesi on at the site of the burn. 
The histopathologic analysis showed the presence 
of an ulcerated malignant melanoma that was growing 
vertically and infiltrating the reticular ·dermis (Clark's 
level III, Breslow's tumour depth 3,5 mm). The neo-
plastic cells showed epithelioid features with an obvious 
peritumoral lymphocytic infiltrate . Immunohistoche-
mical analysis of the skin biopsy revealed that the neo-
plastic cells were positive for S-100 protein, HMB 45, 
acta dermatovenerologica A.P.A. Vol 8, 99, No 4 149 
C ase r e p o r t 
Figure 1. Ulcerative plaque of approximatively 
4 cm in its greatest diameter on the plantar 
surface of the right heel. The ulcerative lesion is 
deep red and with elevated borders. The 
surface was wet and spongy. Two pigmented 
spots, about 2 mm wide, could be observed 
within the lesional area. 
Figure 2. Histopathologic examination of the 
lesion on the plantar surface of the border. 
Hyperkeratosis of the epidermal compartment 
and two nests of neoplastic melanocytes is 
evident. H&E 25x 
Figure 3. Both single and small nests of 
neoplastic melanocytes can be observed in the 
epidermal compartment. H&E 70x. 
anti- PCNA (85%) and negative for Keratin (AEl/ AE3). 
The patient died five years after the initial diagnosis. 
Discussion 
A case of MM, w hich developed after a burn is repor-
ted. It has been impossible to establish if a pigmented 
lesion existed before the trauma occurred . So far, only 
a few cases have been reported demonstrating the 
development of a MM a few weeks after the burn. Most 
of the MM observed after a burn were evident after 
severa! years (3, 4) . This long period of latency may be 
cleterminecl by both the characteristics of the scar tissue 
and the low number of melanocytes in the tissue (1). 
Melanoma in bitumen burn 
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Melanoma in bitumen burn 
The MM of our patient appeared after a short tirne from 
the burn and to the best of our knowledge, it is the first 
case induced by a bitumen burn. 
promoter agents (5). Rockley et al. suggested a rela-
tionship between the occupational exposure to PAH(s) 
and the development of MM (1). Moreover the asphalt 
contains many other agents with a carcinogenetic poten-
tial (6). Mineral oils, also, with a similar composition to 
bitumen distillates proved to have the same activity (7). 
As our patient had been carrying asphalt bitumen for 
about 30 years, it may be possible that the bitumen burn 
acted as promoter of the MM in a site subjected for 
severa! years to carcinogenic initiators. This may also 
explain the severity of the initiator neoplasm and the 
short interval between the burn and the development 
ofthe MM. 
Bitumen contains, even if in small quantities, the 
polycyclic aromatic hydrocarbons (PAHs) that are a 
family of aromatic compounds with carcinogenic 
activity. The PAHs are mutagenic and can act locally by 
chemical induction of melanoma (1). Some studies show 
how the PAHs may produce the apparition of MM in 
animals, both in the hamster after a single topical 
application of 7,12-dimethylbenc (a)-anthracene 
(DMBA) at 1 % and in the mouse after a single topical 
application at 0,2% followed by the exposure to other 
AUTHORS' 
ADDRESSES 
l. Rockley PF, Trieff N, et al. Nonsunlight risk factors far malignant melanoma. Part I: Chemical agents, 
physical conditions and occupation. Int J Dermatol 1994; 33: 398-406. 
2. DelacretazJ, Mevorah B, Pettave!J. Melanome malin apparu dans les suites immediates d'une brulure. 
Soc Fran~ de Derm Syph, Reunion de Paris, Seance du 12 Mars 1970. 
3. Lee JYY, Kapadia SB, Musgrave RH, et al. Neurotropic malignant melanoma occurring in a stable burn 
scar. J Cutan Pathol 1992; 19: 145-50. 
4. Delaunay MM, Courouge-Dorcier D, Castede JC. Malignant melanoma occurring on a burn scar. Ann 
Dermatol Venereol. 1991; 118 (2): 129-30. 
5. Takizawa H, Sata S, Kitajiama H, et al. Mouse skin melanoma induced in two stage chemical 
carcinogenesis with 7,12-dimethyl-benz-(a)-anthracene and croton oil. Carcinogenesis 1985; 6: 921-3. 
6. Wey HE, Breitenstein MJ, Toraason MA. Inhibition of intercellular communication in human keratinocytes 
by fractionated asphalt fume condensate. Carcinogenesis. 1992; 13 (6); 1047-50. 
7. Agarwal R, Shukla Y, Kumar S, Mehrotra NK. Evaluation of carcinogenic effect of jute batching oil 
(JBO-P) fractions following topical application to mouse skin. Arch Toxicol 1988; 62 (6): 406-10. 
Rossana Peila MD, Department oj Dermatology, University oj Padova, Via 
C. Battisti206, 35128 Padova, Italy 
Alessandro Poletti MD, Department oj Pathology, University oj Padova 
Ernesta Clonjero MD, Institute oj Occupational Health, University oj 
Padova, 35128 Padova, Italy 
C leto Veller Fornasa MD, projessor oj dermatology, Department oj 
Dermatology, Universityoj Padova, 35128 Padova, Italy 
Case report 
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