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Our patient, a man in his early 60s, presented with a slow growing skin lesion on the back over two decades along with a recently noticed right axillary mass. During our investigations, a rapid deterioration in the patient\u2019s functional status necessitated hospitalisation and intensive care. We present this rare atypical rapid course to emphasise the value of diagnosis and palliation by a multidisciplinary team to improve quality of life for such patients.<\/jats:p>","DOI":"10.1136\/bcr-2026-275139","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:32:04Z","timestamp":1790613124000},"page":"e275139","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic dedifferentiated malignant melanoma with spindle cell morphology"],"prefix":"10.1136","volume":"19","author":[{"given":"Orkideh","family":"Olang","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-2342","authenticated-orcid":false,"given":"Christopher Jude","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"},{"name":"Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092809301122000_19.9.e275139.1","article-title":"A Case of Dedifferentiated Melanoma With Lymph Node Metastasis Where Molecular Biological Tests Were Useful for Diagnosis","volume":"14","author":"Kamata","year":"2022","journal-title":"Cureus"},{"key":"2026092809301122000_19.9.e275139.2","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.det.2025.03.008","article-title":"Pathology of Melanoma: New Concepts (2025 Update)","volume":"43","author":"Galambus","year":"2025","journal-title":"Dermatol Clin"},{"key":"2026092809301122000_19.9.e275139.3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ejca.2023.03.019","article-title":"Survival in melanoma in the nordic countries into the era of targeted and immunological therapies","volume":"186","author":"Tichanek","year":"2023","journal-title":"Eur J Cancer"},{"key":"2026092809301122000_19.9.e275139.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.22.2771"},{"key":"2026092809301122000_19.9.e275139.5","doi-asserted-by":"crossref","first-page":"102060","DOI":"10.1016\/j.ctrv.2020.102060","article-title":"Dedifferentiated melanomas: Morpho-phenotypic profile, genetic reprogramming and clinical implications","volume":"88","author":"Massi","year":"2020","journal-title":"Cancer Treat Rev"},{"key":"2026092809301122000_19.9.e275139.6","doi-asserted-by":"publisher","DOI":"10.1038\/onc.2015.355"},{"key":"2026092809301122000_19.9.e275139.7","doi-asserted-by":"crossref","DOI":"10.3390\/diseases12090196","article-title":"Malignant Epithelioid Neoplasm versus Dedifferentiated Malignant Melanoma: A Case Report","volume":"12","author":"Rosenberg","year":"2024","journal-title":"Diseases"},{"key":"2026092809301122000_19.9.e275139.8","doi-asserted-by":"crossref","first-page":"494","DOI":"10.3390\/dermatopathology8040051","article-title":"Dedifferentiated Melanoma: A Diagnostic Histological Pitfall-Review of the Literature with Case Presentation","volume":"8","author":"Cazzato","year":"2021","journal-title":"Dermatopathology (Basel)"},{"key":"2026092809301122000_19.9.e275139.9","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/1346-8138.17061","article-title":"Systemic therapy timing and use in patients with advanced melanoma at the end of life: A retrospective cohort study","volume":"51","author":"van Lith","year":"2024","journal-title":"J Dermatol"},{"key":"2026092809301122000_19.9.e275139.10","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/PAS.0000000000001645","article-title":"Dedifferentiated and undifferentiated melanomas: report of 35 new cases with literature review and proposal of diagnostic criteria","volume":"45","author":"Agaimy","year":"2021","journal-title":"Am J Surg Pathol"},{"key":"2026092809301122000_19.9.e275139.11","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2025.1509886","article-title":"Treatment at the end of life in patients with advanced melanoma. 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