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2017 ; 9
(2
): e1026
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Tumoral Melanosis Associated with Pembrolizumab-Treated Metastatic Melanoma
#MMPMID28348944
Bari O
; Cohen PR
Cureus
2017[Feb]; 9
(2
): e1026
PMID28348944
show ga
Tumoral melanosis is a form of completely regressed melanoma that usually
presents as darkly pigmented lesions suspicious for malignant melanoma. Histology
reveals dense dermal and subcutaneous infiltration of melanophages. Pembrolizumab
is an antibody directed against programmed death receptor-1 (PD1) and is
frontline treatment for advanced melanoma. An 81-year-old man with metastatic
melanoma treated with pembrolizumab who developed tumoral melanosis at previous
sites of metastases is described. The PubMed database was searched with the key
words: antibody, immunotherapy, melanoma, melanosis, metastasis, pembrolizumab,
and tumoral. The papers generated by the search and their references were
reviewed. The patient was initially diagnosed with lentigo maligna melanoma on
the left cheek three years earlier, and he was treated with wide local excision.
The patient was subsequently diagnosed with epidermotropic metastatic malignant
melanoma on the left parietal scalp 14 months later and was treated with wide
local excision. Three months later, the patient was found to have metastatic
melanoma in the same area of the scalp and was started on pembrolizumab
immunotherapy. The patient was diagnosed with tumoral melanosis in the site of
previous metastases nine months later. The patient remained free of disease 13
months after starting pembrolizumab. Tumoral melanosis may mimic malignant
melanoma; hence a workup, including skin biopsy, should be undertaken. Extensive
tumoral melanosis has been reported with ipilimumab, and we add a case following
treatment with pembrolizumab. Additional cases of tumoral melanosis may present
since immunotherapy has become frontline therapy for advanced melanoma.