Two primary melanomas. Our patient had 2 different primary melanomas: a melanoma in situ on the right back diagnosed 24 years prior to the current presentation and the more recently identified melanoma on the left abdomen with metastases to the lung and liver.
We referred the patient to Oncology and she was enrolled in a clinical study with ipilimumab and nivolumab, monoclonal antibodies directed against negative regulators of T-cell activation.
DISCUSSION
In the United States, melanoma is the fifth leading cancer in men and the sixth leading cancer in women.1 A prior history of melanoma or melanoma in situ increases the risk for a second melanoma,2-4 and the risk remains elevated for more than 20 years after the initial diagnosis.2 One- and 2-year survival rates for metastatic melanoma are 32% to 65% and 18% to 40%, respectively5; the 5-year survival rate of metastatic melanoma to the lung is approximately 16%.6
Recommendations regarding the appropriate follow-up of patients with a history of melanoma in situ and melanoma vary widely.7 For patients with a history of melanoma in situ, the American Academy of Dermatology and the National Comprehensive Cancer Network recommend annual skin examination indefinitely and self-examination of the skin and lymph nodes monthly.4,7,8
Novel therapies are powerful allies in fight against melanoma
Previous standard treatment of metastatic melanoma included surgery, radiation, and cytotoxic chemotherapy. Resection rarely is curative in distant metastatic melanoma, and cytotoxic chemotherapy has low response rates, has a response duration of 4 to 6 months, and does not improve overall survival in advanced melanoma.9-12
Continue to: Novel therapies...