A case of “buckshot” metastatic melanoma: A rare and aggressive pattern of cutaneous spread

Melanoma is an aggressive skin cancer with high mortality, particularly when not detected early. We present a case of metastatic melanoma in a patient with primary invasive melanoma and a negative sentinel lymph node biopsy who was lost to follow-up. Despite initial negative nodal involvement, the patient later developed head and neck micrometastases, resembling a "buckshot" pattern. We review current sentinel lymph node biopsy guidelines relative to tumor stage and recurrence risk. This case underscores the importance of diligent follow-up in high-risk melanoma patients, even after a negative sentinel lymph node biopsy.