<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932026000100305</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2026.e13142605</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Melanoma cutáneo con debut ganglionar]]></article-title>
<article-title xml:lang="en"><![CDATA[Cutaneous melanoma with lymph node involvement]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fleitas Goiriz]]></surname>
<given-names><![CDATA[Braulio Mauricio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez Núñez]]></surname>
<given-names><![CDATA[María Griselda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Narváez Quinónez]]></surname>
<given-names><![CDATA[Diana Milagros]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Goiburu Chenú]]></surname>
<given-names><![CDATA[María Belén]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aldama Caballero]]></surname>
<given-names><![CDATA[Arnaldo Benjamín Feliciano]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>13</volume>
<numero>1</numero>
<fpage>305</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932026000100305&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932026000100305&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932026000100305&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Entre 9-10% de melanomas debutan con afectación ganglionar regional y el tumor primario puede pasar inadvertido. El examen cutáneo de cuerpo entero y la dermatoscopía permiten la detección de melanomas primarios sutiles, mientras que la estadificación según la AJCC 8ª. orienta al tratamiento específico. Presentamos el caso de un varón de 56 años con una masa axilar derecha de tres meses de evolución, de crecimiento rápido e inicialmente indolora. Además, presentaba una tumoración en el brazo derecho de un año de evolución, que consideraba banal. Tras la evaluación dermatológica se realizó biopsia escisional de la tumoración del brazo derecho. La histopatología, tanto ganglionar como tumoral, y la estadificación por imágenes confirmaron el diagnóstico de melanoma nodular ulcerado con afectación ganglionar (estadio IIIB), por lo que se inició inmunoterapia adyuvante anti-PD-1. Este caso destaca la secuenciación diagnóstica y la búsqueda activa del tumor primario.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Between 9-10% of melanomas present with regional lymph node involvement, and the primary tumor may go unnoticed. Whole-body skin examination and dermatoscopy allow for the detection of subtle primary melanomas, while staging according to the 8th edition of the AJCC guidelines guides specific treatment. We present the case of a 56-year-old man with a rapidly growing, initially painless mass in his right axilla that had been present for three months. He also had a tumor on his right arm that had been present for a year, which he considered trivial. After dermatological evaluation, an excisional biopsy was performed on the tumor on his right arm. Histopathology, both lymph node and tumor, and imaging staging confirmed the diagnosis of ulcerated nodular melanoma with lymph node involvement (stage IIIB), and adjuvant anti-PD-1 immunotherapy was initiated. This case highlights the diagnostic sequence and active search for the primary tumor.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[melanoma]]></kwd>
<kwd lng="es"><![CDATA[dermatoscopía]]></kwd>
<kwd lng="es"><![CDATA[biopsia]]></kwd>
<kwd lng="es"><![CDATA[metástasis linfática]]></kwd>
<kwd lng="en"><![CDATA[melanoma]]></kwd>
<kwd lng="en"><![CDATA[dermatoscopy]]></kwd>
<kwd lng="en"><![CDATA[biopsy]]></kwd>
<kwd lng="en"><![CDATA[lymphatic metastasis]]></kwd>
</kwd-group>
</article-meta>
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