Case 37

Published on 18/02/2015 by admin

Filed under Allergy and Immunology

Last modified 22/04/2025

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CASE 37

WT has been a “sun worshipper” all his life. Over the past several months he has noticed some worrisome changes in some freckles on his legs and arms, and one in particular seems to have grown substantially, with a significant change in coloration and an irregular contour. You recognize all of these signs as being potentially indicative of malignant melanoma and send him to a local dermatologist for biopsy. The results come back positive. WT has heard about some recent positive data using immunotherapy in melanoma and asks your advice.

QUESTIONS FOR GROUP DISCUSSION

RECOMMENDED APPROACH

DIAGNOSIS

WW was diagnosed with malignant melanoma (Fig. 37-1). The most widely used measurement system (after skin biopsy) to predict 5-year survival is the “Breslow” measurement. In this system a defined melanoma thickness is associated with a 5-year survival in 97% of patients. At the other end of the scale a 10-fold increase in thickness is associated with a 5-year survival of only 32% of the patients. Another system, the “Clark Level of Invasion” can also be used to determine prognosis. There are five Clark levels of invasion, with level one indicating that the melanoma is confined to the outermost layer of skin and level five indicating penetration of the melanoma into fat cells beneath the dermis. This is then correlated with 5-year survival rate after surgical removal of the melanoma.

ETIOLOGY: MALIGNANT MELANOMA

Melanoma is indeed a bright spot on the horizon for those interested in the immunotherapy of cancer. It is indeed one of the cancers for which “spontaneous remissions” are reported, which may in turn reflect an autologous antitumor reaction (immunologically derived) in the natural host.

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