Melanoma

Recurrent metastatic melanoma

A 54 year old man developed a black macula over the left mastoid process behind his left ear. Surgical excision revealed a Clark level IV melanoma. A left radical neck dissection revealed two metastases to the anterior cervical chain.  He was free of disease for four years when the development of a dry non-productive cough led to the finding of a left mid lung field pulmonary mass along with a 5.4 x 4.9 cm mediastinal mass displacing the carina. He was treated with a resection of the pulmonary mass and biopsy of the mediastinal mass which revealed metastatic melanoma. He was treated with 36 Immunepheresis procedures targeting soluble receptors to TNF. At the end of these procedures he had complete resolution of the mediastinal mass and no evidence of disease radiographically.  Two years later he developed recurrence in the left upper lip which progressed deep into the left nasolabial fold. He was again treated with Immunepheresis which resulted in a second remission.

Lentigo maligna melanoma

A 52 year old man developed a pigmented plaque in the right cheek immediately anterior to the right ear. It was treated with wide excision and primary closure.  The histology was lentigo maligna melanoma. His initial staging work-up was negative for metastatic disease. Six years later he developed progressive right cervical adenopathy.   A right radical neck resection revealed melanoma but complete excision was not surgically possible. The patient received interferon alpha standard ECOG protocol but the disease progressed to a large 15 x 10 x 8 cm mass of ulcerated tumor.  He was then treated with 24 Immunepheresis procedures which resulted in massive avascular necrosis of the mass and decrease in size to 4 x 4 x 1 cm. The mass was then resected with clear margins and a small skin graft used to close the defect.

Recurrent metastatic melanoma

A 34 year old woman had a history of resection of a Clark level III melanoma from the left forearm. One year later she presented progressive adenopathy in the left axilla. Staging work-up revealed no evidence of visceral metastases. She was treated with 12 Immunepheresis procedures which resulted in inflammatory pain, ache and edema in the lymph nodes of the axillae. At the end of the inflammatory response, surgical exploration of the axilla revealed extensive tumor necrosis and reparative fibrosis but no active melanoma.