First Case of Primary Breast Melanoma in Central America: Case Report and Literature Review.

Primary breast melanoma is an exceedingly rare neoplasm, accounting for < 0.5% of all malignant breast tumors. Its scarcity and highly variable clinical presentation often delay diagnosis and complicate management. We report the case of a 55-year-old woman with a primary non-cutaneous melanoma of the right breast initially misdiagnosed as high-grade ductal carcinoma. As a result of discordant biopsy results, the lesion progressed developing ulceration, tissue destruction, and axillary metastases. Definitive diagnosis was established via repeated incisional biopsies and immunohistochemistry. Management comprised neoadjuvant dacarbazine (discontinued owing to toxicity and disease progression), modified radical mastectomy, delayed split-thickness skin graft, targeted antibiotic therapy for a carbapenemase-producing infection, adjuvant carboplatin-paclitaxel, and locoregional radiotherapy. Twelve months later, right-side inguinal nodal metastases were resected and irradiated. At 18-month follow-up, the patient remains disease-free. This case underscores the diagnostic and therapeutic challenges of primary breast melanoma and highlights the importance of early multidisciplinary care.