Neoadjuvant treatment of melanoma: case reports and review

Abstract

Neoadjuvant therapy is an under-utilized regimen for the treatment of metastatic melanoma. The use of this approach has been increasing in other tumor types. Neoadjuvant therapy may reduce occult circulating tumor cell burden in the face of bulky disease and afford a real time evaluation of treatment effectiveness. Neoadjuvant approach can also provide preoperative histologic and molecular analysis of treated tissue that may guide the postoperative treatment planning in patients with resectable metastatic melanoma lesions. The putative benefits of better margin control and clearance of occult systemic disease would theoretically improve surgical outcome. With the advent of effective agents against metastatic melanoma, this common approach to the treatment of rectal cancer, metastatic colon cancer, and breast cancer should also be evaluated as a viable treatment strategy for advanced stage melanoma.

Figure 1

Pre- and post-treatment CT images for patient 1. A. Initial metastatic disease. Small pulmonary nodules on the right anterior and posterior lungs and a 5.4 cm lesion in the right lobe of the liver. B. Post-treatment. Stability or reduction in sizes of right lung lesions, but progression of right lobe of liver lesion to 7 cm. C. Post right hepatectomy. Continued regression and resolution of right lung lesions, and surgical resolution of right liver lesion.

Figure 2

Pre- and post-treatment CT images for patient 2. A. Pre-treatment CT images of metastatic lung nodules and splenic metastases. B. Post-treatment CT images of resolving lung and splenic metastases. C. Twenty month post-treatment CT images of resolved lung and splenic metastases.

Figure 3

Pre- and post-treatment PET/CT images for patient 2. A. Pre-treatment PET/CT image of rectal lesion. B. Post-treatment PET/CT image of rectal lesion. C. Post-resection PET/CT image of rectal lesion.