A 79-year-old female patient with a history of appendectomy and cholecystectomy was diagnosed with hypertension and diabetes mellitus. She was referred to an outpatient clinic with a complaint of a 3 × 4 cm mass that had been located in the right parotid region for eight months and recently grew rapidly to cause total facial nerve palsy. The mass was mobile, and the patient did not report pain. The patient's computed tomography (CT) indicated a lobular-contoured, 4 × 2.5 cm solid mass lesion with heterogeneous contrast enhancement in the anterior lobe of the right parotid gland (). A fine needle aspiration biopsy revealed a malignancy of an unknown type. Neither physical and endoscopic examinations nor positron emission tomography-computed tomography (PET-CT) checks succeeded in establishing the primary origin of the malignancy.\nHowever, an elevated skin flap revealed a pigmented lesion that had infiltrated the superficial parotid gland. Following a frozen-section examination, the patient was diagnosed with melanoma. We observed the temporozygomatic and buccal branches of the facial nerve penetrating a 5 × 6 cm mass originating from the superficial lobe of the parotid gland (). We then performed a total parotidectomy operation in which we resected the temporozygomatic and buccal branches and dissected the deep lobe. The results of an immunohistochemical analysis found the melanoma to be HMB-45 positive, S100 positive, Melan-A positive, and PanCK negative. These findings verified the malignant melanoma diagnosis (Figures , , , and ).\nNo primary origin of the melanoma was detected in the head, the neck, or any other region during the patient's postoperative dermatology consultation. Considering the possibility that the primary metastatic malignant melanoma might have regressed, we decided to check the patient's earlier photographs. Upon examination of photographs that were taken five to six years ago, we detected a 3 × 3 cm hyperpigmented lesion in the right facial region (Figures and ). The patient reported that the lesion gradually disappeared spontaneously. We considered the possibility that the metastatic malignant melanoma's primary tumor was likely to have regressed at a later time.
A 60-year-old multiparous postmenopausal female patient, with no prior known medical or surgical comorbidities or any drug allergy, presented with a history of lump in the right breast of 4 weeks’ duration which is gradually increasing in size. The lump was not associated with any pain, deformity, or bloody nipple discharge. There was no history of any axillary swelling, trauma, surgery, or systemic symptoms such as fever or weight loss. Family history was insignificant. On examination, there was 4 cm × 3 cm lump in the lower quadrant of the breast, not fixed to underlying structures or skin. The fine-needle aspiration cytology (FNAC) of lump was suspicious of malignancy, while biopsy revealed invasive ducal carcinoma Grade III, which demonstrated estrogen and progesterone receptor positive and HER2/Neu receptor negative. She underwent right breast conservation surgery with oncoplastic reconstruction. Final histopathology report revealed an invasive ducal carcinoma Grade III, with tumor size of 2.3 cm × 3.0 cm and node negative status, that is, Stage IIA (T2N0M0) breast cancer. She received six cycles of adjuvant chemotherapy with five flurouracil, epirubicin, and cyclophosphamide followed by adjuvant radiation therapy and then started on adjuvant hormonal therapy with tablet anastrozole 1 mg OD.\nWithin 9 months of adjuvant endocrine therapy, she presented with swelling over right preauricular region which she noticed incidentally. There was no history of any associated pain, trauma, sialorrhea, or difficulty in chewing food. PET scan revealed a focus of increased avidity in the right parotid gland without any metastatic focus elsewhere in the body [] while contrast-enhanced computed tomography (CT) fused 18F-fluorodeoxyglucose (18F-FDG) PET/CT axial and coronal sections showed a well-defined nodular lesion measuring 1.8 cm × 1.7 cm × 1.6 cm in the right parotid gland with good postcontrast enhancement and mild FDG avidity []. She underwent right superficial parotidectomy with Level II and Level III neck node dissection which revealed metastatic infiltrating ductal carcinoma involving the right parotid gland with intraparotid node [Panel A, ]. On immunohistochemistry, cells were positive for CK 7 and GATTA 3, while negative for CK 20, PAX 8, and TTF1 suggesting metastasis from breast primary [Panel B, ]. In view of limited parotid metastasis and no other evidence of any visceral crisis, she was started on second-line hormonal therapy with tablet exemestane 25 mg OD and tablet everolimus 5 mg OD. At resent, she is on regular follow-up on same second-line hormonal therapy and disease free for the last 16-month postsurgery.