Understand the current therapeutic landscape for high-risk localized cutaneous melanoma
Review treatment strategies for high-risk regionally metastatic melanoma
Discuss management options for patients with metastatic melanoma
Synopsis
A 71-year-old Male with a history of NMSC presents for follow up to discuss the pathology results of a recent biopsy of a pigmented lesion on his back
Pathology reveals:
HISTOLOGIC TYPE: Superficial spreading melanoma
PRECURSOR LESION: Not identified
MAXIMUM TUMOR THICKNESS: 3.0 mm
ANATOMIC LEVEL: At least level IV
ULCERATION: Present
MITOTIC RATE: 9 per mm2
LYMPHOVASCULAR INVASION: Present, Foci suspicious for lymphovascular invasion
METHOD OF DETECTION: Hematoxylin and eosin
RADIAL GROWTH PHASE: Present
VERTICAL GROWTH PHASE: Present
TYPE OF VERTICAL GROWTH: Epithelioid
MICROSATELLITES: Cannot be assessed
PERINEURAL INVASION: Cannot be assessed
TUMOR-INFILTRATING LYMPHOCYTES: Present, nonbrisk
TUMOR REGRESSION: Absent
MARGINS: Extending to inked lateral and deep resection margins
Case 1 Clinical Questions:
What is this patient’s T stage?
What would be your next steps in work up?
What would be your surgical plan?
What additional studies (if any) would you order?
Synopsis
A 68-year-old Male with a history of HTN, HLD, T3bN1aM0 melanoma presents for follow up to discuss next steps in management.
Relevant Work Up To Date:
Tumor:
3.2 mm thick, ulcerated SSM with 5 mitoses, Right mid back
Nodal:
1/14 nodes positive for melanoma on sentinel lymph node biopsy
Imaging:
No evidence of distant disease
Molecular Testing:
BRAF p.V600E (c.1799T>A): absent
BRAF p.V600K (c.1798_1799delGTinsAA): present
INTERPRETATION: POSITIVE for variant in BRAF.
Case 2 Clinical Questions:
What is this patient’s pathological stage?
What are the therapeutic options for this patient?
Synopsis
A 58-year-old Female with a history of HTN, HLD, presents with a 3 cm ulcerated pigmented lesion on the right thigh. Physical exam reveals a 6 cm right inguinal mass.
Case 3 Clinical Questions:
What are your next steps in management?
If regionally metastatic melanoma is confirmed, what management options are available?
Synopsis
A 49-year-old Male with a history of pulmonary sarcoidosis presents with BRAF V600 mutated melanoma metastatic to the liver and lungs.
Case 4 Clinical Questions:
What therapeutic strategies are available for this patient?
Given the patient’s comorbidities, what would be your first-line treatment strategy?
Interactive Timeline of FDA-Approved Therapies for Melanoma