Prognosis and Diagnosis of Advanced Melanoma


Michael B Atkins, MD, shares insights on the prognosis of patient’s diagnosed with advanced melanoma and discusses the value of BRAF mutation testing.

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
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