The patient is a very pleasant and healthy 46-year-old who has a bone lesion in the right proximal humerus. This was discovered incidentally during a workup for a separate process. He had swelling in the left arm and the workup included imaging studies that showed the lesion in the right shoulder.

The patient has a history of malignant melanoma which affected the left elbow and the chest wall. He has had complete removal, and is apparently now free of disease, and is regularly followed in the pigmented lesion clinic at the MGH.

The rest of the history is noncontributory.

Exam findings are limited to the right shoulder, where no mass is felt at the location of the lesion, and no tenderness. No axillary or cervical lymphadenopathy. There is a full range of motion. Distally, the pulsations of the radial artery and the neurovascular status are normal.

A bone scan, plain radiographs, and an MRI show an expansile, active appearing lesion in the right proximal humerus near the surgical neck. It is on the anterolateral portion of the humeral head. It measures about 3.5 cm in total length and about 2.5 cm in width and in depth.

There is the risk that this lesion arises from metastatic malignant melanoma, although metastasis of melanoma to bone is unlikely. Approximately 70% of malignant melanoma recurrence appears as a local recurrence or a recurrence in regional lymph nodes. A rare case of metastasis of a thoracic melanoma to the bones of the foot has been reported.

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