Can Melanoma Metastasize and Cause Facial Asymmetry?
Yes, melanoma can metastasize and cause facial asymmetry through direct cutaneous metastases to facial skin or subcutaneous tissues, though this represents an advanced stage of disease.
Metastatic Potential of Melanoma
Melanoma is highly aggressive with propensity for early lymphogenic and hematogenic metastasis 1. The tumor can metastasize to virtually any organ system, with distant skin and subcutaneous tissues being recognized metastatic sites classified as M1a disease in the AJCC staging system 2.
Mechanisms of Facial Asymmetry
Facial asymmetry in melanoma patients can occur through several pathways:
- Cutaneous and subcutaneous metastases to facial tissues can create visible asymmetry through nodular lesions or tissue distortion 2, 3
- Lymph node involvement in cervical or parotid regions can cause facial swelling and asymmetry
- Direct extension from primary facial melanomas with satellites or in-transit metastases 2
Clinical Recognition
When evaluating facial asymmetry in a melanoma patient, examine for:
- Skin nodules on the face, which may appear as flesh-colored or pigmented lesions representing cutaneous metastases 3
- Palpable lymphadenopathy in cervical or parotid regions causing contour changes 2
- Multiple lesions elsewhere on the body, as metastatic melanoma typically presents with widespread disease rather than isolated facial involvement 3
Prognostic Implications
The presence of distant cutaneous metastases causing facial asymmetry indicates:
- Stage IV disease (M1a with normal LDH, or M1c if LDH elevated) 2
- Poor prognosis, particularly if presenting with metastatic disease at initial diagnosis, which occurs in only 4% of cases 3
- Need for systemic therapy including BRAF-targeted therapy (if BRAF V600E mutation present) or PD-1-based immune checkpoint therapy 1, 3
Common Pitfall
Do not confuse facial asymmetry from melanoma metastases with the asymmetry criterion (the "A" in ABCDE) used for diagnosing primary melanoma lesions 4, 5. The ABCDE rule refers to asymmetry within a single pigmented lesion, not facial contour asymmetry from metastatic disease.