Metastatic malignant melanoma presenting as bilateral acute mastitis in a lactating woman: a case report and literature review.

Malignant melanoma, an aggressive neoplasm with high metastatic potential, rarely metastasizes to the breast, with bilateral involvement being exceptionally uncommon. This case report details a 36-year-old postpartum woman who presented with bilateral, symmetrical, rock-hard breast swelling and erythema, initially misdiagnosed as severe lactational mastitis. Comprehensive evaluation ultimately revealed diffusely metastatic malignant melanoma. The primary site was identified as a previously excised cutaneous lesion on the chest wall, originally reported as a benign compound nevus. The patient exhibited a rapidly progressive and refractory disease course, failing to respond to sequential targeted therapy, immunotherapy, and chemotherapy, and succumbed to the disease within seven months of diagnosis. This case underscores a profound diagnostic pitfall, highlighting the potential for metastatic melanoma to mimic benign inflammatory breast conditions, particularly in the physiologically altered postpartum period. It emphasizes the critical need for a high index of suspicion for metastatic disease in atypical breast presentations and reinforces the imperative of meticulous history-taking, including a thorough review of all prior skin pathology, in patients with malignancy of unknown origin. The aggressive clinical course further illustrates the formidable therapeutic challenges in such advanced presentations of metastatic melanoma.