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Case Reports
. 2023 May 5;13(9):1635.
doi: 10.3390/diagnostics13091635.

The Benefits and Challenges of the Multimodal Treatment in Advanced/Metastatic Malignant Melanoma

Alexandru-Rares Stoian  1   2 , Gabriela Rahnea-Nita  1   3 , Anda-Natalia Ciuhu  3 , Laurentia Gales  1   4 , Rodica-Maricela Anghel  1   4 , Laura-Florentina Rebegea  5   6   7 , Roxana-Andreea Rahnea-Nita  1   3 , Liliana-Florina Andronache  1 , Ioana Soare  8 , Gabriela Stoleriu  6
Affiliations
Case Reports

The Benefits and Challenges of the Multimodal Treatment in Advanced/Metastatic Malignant Melanoma

Alexandru-Rares Stoian et al. Diagnostics (Basel). .

Abstract

Currently, the treatment of malignant melanoma offers the longest and the most studied experience of innovative treatments in malignant pathology. The algorithm of the therapeutic decision in advanced or metastatic melanoma must comprise: the timing of the therapeutic initiation, the sequencing of the specific oncological treatment (radiotherapy and chemotherapy still being therapeutic alternatives in selected cases), the diagnosis and the management of adverse reactions. We present the case of a patient diagnosed with metastatic malignant melanoma in November 2019, who progressed successively under new systemic treatment throughout the 3 years of treatment and experienced skin reactions of various degrees of severity. The comprehensive response to secondary hilar pulmonary lymphatic determinations under subsequent chemotherapy was specific to the presented case. The occurrence of vitiligo secondary to immunotherapy is a favorable prognostic factor, but the occurrence of secondary cerebral determinations is an extremely severe prognostic factor in malignant melanoma and a challenge in making the therapeutic decision. Previous treatment with immune checkpoint inhibitors may trigger a favorable response to systemic chemotherapy. The early and accurate diagnosis of the adverse events of the new therapies requires a multidisciplinary approach, because it can radically change the therapeutic decision.

Keywords: adverse events; chemotherapy; malignant melanoma; new therapeutic approach.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Melanoma relapse, at the time of the patient’s admission to the Surgical Department of our team.
Figure 2
Figure 2
Vitiligo-like lesions in the areas exposed to the sun: (a) face and forehead; (b) dorsal side of the left hand; (c) face, forehead and left side of the neck; (d) dorsal side of the right hand.
Figure 3
Figure 3
(a) Two nodular images, with the hyperechoic center of 0.66 and, respectively, 0.53 cm, between external to common carotid artery (CCA) and internal jugular vein (IJV). (b) Hypoechoic nodular image, with Doppler signal in the hilum, the transverse diameter of 2.57/2.42 cm; longitudinal diameter of 4.54/2.14 cm, between internal carotid artery (ICA) and external carotid artery (ECA), in direct contact with the vessels.—April 2021.
See this image and copyright information in PMC

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