European Journal of Radiology 56 (2005) 362–364 Case report Malignant melanoma with metastasis into the capitate Xavier Tomas a,* , Carles Conill b , Andreu Combalia c , Jaume Pomes a , Teresa Castel d , Carlos Nicolau a a Radiology Department (CDIC), Hospital Cl´ ınic, Institut d’Investigaci´ o Biom` edica August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain b Radiotherapy Department (ICMHO), Hospital Cl´ ınic, Institut d’Investigaci´ o Biom` edica August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain c Orthopaedics Department (ICEMEQ), Hospital Cl´ ınic, Institut d’Investigaci´ o Biom` edica August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain d Dermatology Department (ICMiD), Hospital Cl´ ınic, Institut d’Investigaci´ o Biom` edica August Pi i Sunyer (IDIBAPS), Facultat de Medicina, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain Received 15 April 2005; received in revised form 3 June 2005; accepted 9 June 2005 Abstract Metastases to the hand and wrist are rare, with fewer than 200 cases reported in the literature. Phalanges are more commonly involved than metacarpal and wrist. The lung, breast and kidneys are the more common sites of primary lesions than metastasize in the hand. We present an exceptional case of melanoma that metastasized to the capitate. Melanoma can give bone metastases, but we are not aware of reports of this tumour metastatising to the carpal bones. In our knowledge, we have only found a report of metastases in the capitate, a clear-cell sarcoma of the right foot, a tumour close to melanoma with some cytogenetic differences. Hand metastases in a patient who is suffered melanoma should be ruled out if a lytic aggressive lesion appears on x-ray film or positive technetium bone scan is demonstrated. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Bone neoplasms; Diagnostic radiology; Melanoma; Wrist 1. Case report A 25-year-old woman with biopsy-proven (Breslow level 3.71 mm) melanoma in the interscapular region was treated with wide local resection and axillary lymphadenectomy, which revealed none of 13 nodes to be positive. Twenty months after surgery the patient started having mechanical pain in the right shoulder and wrist. Whole body skele- tal scintigraphy showed focal areas of intense uptake in right acromial bone and wrist. X-ray films showed osteolytic lesions in both areas. In the wrist, a lytic image, with thin septa and non-well defined margins was depicted on cap- itate bone. Cortical thinning and destruction was seen on radial side (Fig. 1). No other radiological abnormalities were * Corresponding author. Tel.: +34 932 275 412; fax: +34 932 275 454. E-mail address: 22812xtb@comb.es (X. Tomas). found. The patient underwent CT-guided biopsy of the acro- mial lesion due to easy access (Fig. 2), and histopathology was positive for metastatic melanoma. One month later the patient developed metastatic supr- aclavicular node and multiple subcutaneous metastases. At this time chemoimmunotherapy with DTIC 800 mg/m 2 , vin- blastine 1.5 mg/m 2 , CDDP 80 mg/m 2 , interferon alfa-2b 5 mUI/m 2 and interleukine-2 4,5 mUI/m 2 was started. After 6 cycles the patient complaint the onset of headaches and CT scan showed multiple irregular enhancing lesions with perile- sional oedema, consistent with metastatic disease. Radiation therapy was initially delivered to the whole brain up to a total dose of 20 Gy in five fractions, chemotherapy program was interrupted and Temozolomide as single agent chemotherapy was started. Eventually, additional widespread metastases in right adrenal, lung and skin developed and unsuccessfully the patient died. 0720-048X/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2005.06.007