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