Immunotherapy in Metastatic Mucosal Melanoma with Disseminated Intravascular Coagulation: A Case of Success

Mucosal melanoma accounts for 1% of all melanomas. It is more aggressive than cutaneous melanoma, and local excision provides the best disease-free survival. The vast majority of patients eventually develop metastases, with a metastatic pattern independent of the primary tumor site. While studies show that BRAF and KIT inhibitors have a role in the management of these patients, the actual treatment focus is on immunotherapy. Herein is described the case of a 79-year-old woman with metastatic mucosal melanoma and bone marrow infiltration causing disseminated intravascular coagulation, who was treated with an immunotherapy combination (anti-CTLA-4 and anti-PD-1 antibodies), achieving complete disease remission. This is the third case of melanoma with disseminated intravascular coagulation at presentation and the second case treated with immunotherapy in the literature, but the only one achieving disease remission.

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Mucosal Melanoma of the Head and Neck: Tata Memorial Hospital Experience

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1028 ◽

2010 ◽

Vol 1 (3) ◽

pp. 141-145 ◽

Cited By ~ 1

Author(s):

Vedang Murthy ◽

Ashwini Budrukkar ◽

Gupta Tejpal ◽

Jai Prakash Agarwal ◽

Suruchi Singh ◽

...

Keyword(s):

Head And Neck ◽

Surgical Resection ◽

Adjuvant Radiotherapy ◽

Disease Free Survival ◽

Mucosal Melanoma ◽

Locoregional Control ◽

Free Survival ◽

Tata Memorial Hospital ◽

Aggressive Tumor ◽

Disease Free

Abstract Background Primary mucosal melanoma of the head and neck (MMHN) is a rare, aggressive tumor of neural-crest origin. Despite universal progress in cancer care, the prognosis of MMHN continues to remain dismal. Aims To analyze and report the outcomes of primary head and neck mucosal melanomas treated at Tata Memorial Hospital. Methods Retrospective chart review of all patients with a diagnosis of nonocular MMHN presenting to the institute between 1995 to 2003. Locoregional control and disease-free survival were used as outcome measures. Results 42 patients presenting within the study period with nonocular MMHN (oral-55%, sinonasal-40%, and pharyngeal-5%) at a median age of 53 years constituted the demographic cohort. 11 (26%) patients not amenable to any active anticancer treatment were treated with best supportive care alone and excluded from outcome analysis. 26 patients underwent surgery with complete resection of tumor. Seven (27%) also received adjuvant radiotherapy due to the adverse histopathologic features. Two patients were treated with radical radiotherapy due to unresectability, two patients received palliative chemotherapy, while one patient was treated with definitive chemoradiotherapy. With a mean follow-up of 11 months (range 1-58 months), the 3-year locoregional control and disease-free survival was 41% and 12% respectively. Age, sex, site of primary, tumor stage, surgical resection, margin status, depth of infiltration, and adjuvant radiotherapy did not affect outcome significantly. Conclusion Primary mucosal melanoma of the head and neck is a rare, but, aggressive tumor with a dismal prognosis. Surgical resection with clear margins offers the best chance of cure for early localized disease. The high incidence of locoregional as well as distant failures after surgical resection supports the use of adjuvant therapy. Deeper insights into the pathobiology of disease can help develop more specific and effective treatment strategies to improve long-term outcomes.

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Primary small-intestinal lymphomas in Taiwan: immunoproliferative small-intestinal disease and nonimmunoproliferative small-intestinal disease.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.7.1375 ◽

1994 ◽

Vol 12 (7) ◽

pp. 1375-1382 ◽

Cited By ~ 16

Author(s):

L Y Shih ◽

S J Liaw ◽

P Dunn ◽

T T Kuo

Keyword(s):

Combination Chemotherapy ◽

Disease Free Survival ◽

Large Cell ◽

Intestinal Disease ◽

Primary Tumor Site ◽

Free Survival ◽

Immunoproliferative Small Intestinal Disease ◽

Small Intestinal ◽

Disease Free ◽

Small Intestinal Disease

PURPOSE The clinicopathologic findings in 45 adult Chinese patients with primary small-intestinal lymphoma (PSIL) are described and compared with those in Western countries and in underdeveloped nations. The efficacy of combination chemotherapy is also assessed. PATIENTS AND METHOD Six patients had immunoproliferative small-intestinal disease (IPSID) indicated by the presence of alpha-heavy chain protein (alpha-CP) in body fluids or tumor tissues. Thirty-nine patients had non-IPSID, including one with postrenal transplant lymphoma. Thirty-three non-IPSID patients received a minimum of four cycles of combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). RESULTS All IPSID patients presented with the clinical and laboratory features of severe intestinal malabsorption, and all had diffuse lymphoplasmacytic infiltration in the mucosa of the small bowel. Lymphomas were localized mainly in the jejunum and mesenteric nodes. The histologic subtypes were diffuse large cell in two, immunoblastic in three, and diffuse mixed in one. All patients responded poorly to chemotherapy, with a median survival duration of 10.5 months. The common presenting symptoms of the 39 non-IPSID patients included abdominal pain (90%), weight loss (31%), abdominal mass (26%), obstruction (26%), and perforation (23%). Diffuse large-cell and immunoblastic lymphomas constituted 82% of cases. Four patients had stage IE, 19 stage II 1E, and 16 stage 112E disease according to the Musshoff's criteria; 22 had bulky tumors and 19 had multiple tumors. The tumors were completely resected in 14 patients. Of 33 patients treated with combination chemotherapy, 73% achieved a complete remission. With a median follow-up duration of 90 months, there have been four relapses, with only one at the primary tumor site. The overall 5-year survival and disease-free survival rates for non-IPSID patients who were treated with chemotherapy were 59% and 54%, respectively. CONCLUSION Intensive chemotherapy produces long-term disease-free survival in locally advanced non-IPSID PSIL.

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Establishing and Assessing a Nomogram Based on the Clinical Features of Mucosal Melanoma of the Head and Neck

10.21203/rs.3.rs-230826/v1 ◽

2021 ◽

Author(s):

Qing-Qing Xu ◽

Qing-Jie Li ◽

Liu Chen ◽

Xin-Yi Su ◽

Jing-Xia Song ◽

...

Keyword(s):

Head And Neck ◽

Clinical Features ◽

Cox Regression ◽

Disease Free Survival ◽

High Risk Group ◽

Mucosal Melanoma ◽

Characteristic Analysis ◽

Primary Tumor Site ◽

Free Survival ◽

Kaplan Meier

Abstract Objectives: The rarity of mucosal melanoma of the head and neck (MMHN) and the lack of prospective clinical trials has resulted in the limited knowledge of its clinical features and prognosis. We aimed to understand the clinical characteristics and developed a nomogram to better predict the prognosis of patients with MMHN.Methods: Based on a total of 300 patients with nonmetastatic MMHN, multivariable Cox regression was performed to analyze independent prognostic factors. The overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) of MMHN patients could be monitored using the nomogram. To facilitate clinical application, an online dynamic nomogram was established.Results: Multivariate analysis identified primary tumor site, T stage and N stage as independent risk factors for survival. This factor-based nomogram had prognostic value for OS, DFS, DMFS, and LRRFS. Receiver operating characteristic analysis indicated the high diagnostic accuracy of the nomogram (AUC > 0.7). Kaplan–Meier survival curves indicated that the risk score of the nomogram effectively stratified MMHN patients with poor survival into a high-risk group (all P<0.001). Conclusions: The nomogram is conducive to stratifying MMHN patients into clinically meaningful taxonomies and subsequently providing individualized treatment.

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A nomogram for predicting survival of head and neck mucosal melanoma

Cancer Cell International ◽

10.1186/s12935-021-01927-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qing-Qing Xu ◽

Qing-Jie Li ◽

Liu Chen ◽

Xin-Yi Su ◽

Jing-Xia Song ◽

...

Keyword(s):

Head And Neck ◽

Cox Regression ◽

Disease Free Survival ◽

Predictive Performance ◽

Risk Groups ◽

Mucosal Melanoma ◽

Primary Tumor Site ◽

Free Survival ◽

N Stage ◽

Independent Risk Factors

Abstract Objectives We aimed to understand the clinical characteristics and better predict the prognosis of patients with mucosal melanoma of the head and neck (MMHN) using a nomogram. Methods Three hundred patients with nometastatic MMHN were included. Multivariable Cox regression was performed to analyze independent prognostic factors for overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS), and these factors were used to develop a nomogram. Concordance indexes (C-indexes), calibration plots, and receiver operating characteristic (ROC) analysis were performed to test the predictive performance of the nomogram in both the primary (n = 300) and validation cohorts (n = 182). Results The primary tumor site, T stage and N stage were independent risk factors for survival and were included in the nomogram to predict the 3- and 5-year OS, DFS, DMFS, and LRRFS in the primary cohort. The C-indexes (both > 0.700), well-fit calibration plots, and area under the ROC curve (both > 0.700) indicated the high diagnostic accuracy of the nomogram, in both the primary and validation cohorts. The patients were divided into three groups (high-risk, intermediate-risk, and low-risk groups) according to their nomogram scores. The survival curves of OS, DFS, DMFS, and LRRFS were well separated by the risk groups in both cohorts (all P < 0.001). Conclusions The nomogram can stratify MMHN patients into clinically meaningful taxonomies to provide individualized treatment.

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