ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Case Studies: The Therapeutic Approach for Malignant Melanoma

In this case-based interview, Michael A. Davies, MD, PhD, provides an overview on the treatment of newly-diagnosed metastatic melanoma and recurrent metastatic melanoma.

The Therapeutic Approach for Malignant Melanoma: Case 1

June 2010

  • A 73-year-old Caucasian male presented to his physician with a right pre-auricular pigmented lesion, 8 mm-diameter
  • PMH: arterial hypertension, dyslipidemia, hyperuricemia and hypothyroidism, for which he has been medically treated
  • He is a non-drinker and a former smoker
  • In 2002, he had undergone a right nephrectomy for a spontaneous retroperitoneal hematoma. Consequently, he has chronic renal insufficiency
    • Creatinine, 1.8 mg/dL
    • GFR, 40 mL/min
  • He otherwise maintains full autonomy in his daily activities and personal care
  • He subsequently underwent surgical resection. Pathologic assessment revealed an ulcerated melanoma
    • Breslow index 0.8 mm
    • Clark level of III (pT1b, Stage IB)
  • Since his surgery, he remains active and continues golfing 3 times per week

June 2016

  • On routine follow-up, the patient presents with moderate asthenia that limited his daily activity, without other relevant clinical symptoms (ECOG PS 1)
  • Physical examination did not detect any relevant findings
  • Remarkable laboratory findings: Urea, 70 mg/dL; Creatinine 1.76 mg/dL; AST, 59 UI/L; ALT 52 UI/L; GGT 363 UI/L; Alk Phos, 204; LDH, 820 UI/L
  • Full-body CT scan revealed the presence of pulmonary and hepatic nodules, no evidence of brain metastases
  • He underwent core-needle biopsy of the largest hepatic lesion in segment IVb without any complications
    • Pathology revealed metastatic melanoma
    • Mutation testing: BRAF-negative

 

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