Prognosis and Diagnosis of Advanced Melanoma

EP: 1.Patient Case: A 62-Year-Old Female with Stage IV BRAF-Mutated Melanoma

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EP: 2.Prognosis and Diagnosis of Advanced Melanoma

EP: 3.Treatment Options for Metastatic Melanoma

EP: 4.First-Line and Sequencing Treatment Decisions

EP: 5.Treating Stage IV BRAF-Mutated Melanoma

EP: 6.Managing Immune-Related Adverse Events

EP: 7.Second-Line Treatments for Metastatic Melanoma

EP: 8.Investigative Treatments for Metastatic Melanoma

Case: A 62-Year-Old Female with Stage IV Melanoma

• A 62-year-old female consulted with her dermatologist for removal of a pigmented lesion that had recently become darker.
  • She noted that she had been experiencing persistent fatigue, shortness of breath, and a dry cough that she attributed to a prior COVID-19 infection.
  • LDH: 174 UI/L
• Excisional biopsy reveals melanoma with a Breslow depth of 1.2 mm, ulcerated, mitotic rate 4/mm2
  • The patient underwent wide local excision and sentinel node mapping
  • Staining was positive for melanoma in the right axillary node
  • CT of the chest, abdomen, and pelvis indicated multiple lesions in both lungs
  • The patient underwent core-needle biopsy of the largest lung lesion, measuring 1 cm
  • Pathology revealed metastatic melanoma, cutaneous nonacral with a positive BRAF V600E mutation
  • ECOG PS 1
• Diagnosis: Stage IV Melanoma, T2b N1a M1b

This is a video synopsis/summary of a Case-Based Peer Perspectives episodefeaturing Michael B. Atkins, MD.

In 2011, the median overall survival for patients with stage IV melanoma and M1B disease was 6 to 9 months, with only 10% to 20% alive at 2 years. Now with available therapies for metastatic melanoma, a patient with M1B disease has a 70% to 75% chance of 2-year survival and a greater than 60% 5-year survival, with most 5-year survivors off treatment and likely cured.

This 62-year-old woman represents a typical case. Median age in clinical trials is approximately 60 years. Lung metastases are a common first site, and brain metastases are rare at presentation. This raises the question of optimal treatment for the best chance of long-term survival.

Recommendations for such patients include getting a brain MRI, which this patient had, and testing for BRAF mutation. In contrast to lung cancer, only BRAF mutation analysis is typically needed, rather than more extensive next-generation sequencing that can take 2 to 3 weeks. A simple BRAF test can be done quickly with various methods to help guide treatment decisions about immunotherapy or targeted therapy choices. With rapidly progressive disease, targeted BRAF/MEK inhibitor treatment may help slow tumor growth more quickly than waiting several weeks for sequencing results.

Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.