Ipilimumab (at a dose of 10 mg per kilogram) in combination with dacarbazine, as compared with dacarbazine plus placebo, improved overall survival in patients with previously untreated metastatic melanoma. The types of adverse events were consistent with those seen in prior studies of ipilimumab; however, the rates of elevated liver-function values were higher and the rates of gastrointestinal events were lower than expected on the basis of prior studies. (Funded by Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00324155.).

These results demonstrate durable survival in a significant proportion of patients with metastatic melanoma who received ipilimumab therapy.

No abstract

Malignant melanoma is an aggressive skin cancer with no effective therapies currently approved for advanced disease. In the case presented, a 55-year-old female patient diagnosed with widespread disease from amelanotic desmoplastic melanoma was treated with 10 mg/kg ipilimumab as part of a phase II clinical trial (CA184-008). Prior to ipilimumab, three chemotherapeutic regimens had failed. Ipilimumab acts as a T-cell potentiator via blockade of cytotoxic T-lymphocyte antigen-4, a negative regulator of T-cell activation. Response to ipilimumab treatment was rapid, with a substantial drop in tumor volume within 12 weeks of treatment initiation. Based on the appearance of a new subcutaneous lesion, reinduction with ipilimumab was performed at Week 30. Following reinduction, the appearance of another small new lesion made the patient ineligible, as per protocol, for further dosing despite stabilization of her remaining lesions. Ipilimumab-associated immune-related adverse events were manageable with the use of treatment guidelines. It is of remarkable immunotherapeutic importance that no new lesions emerged and gradual tumor regression is still ongoing more than 2 years following the last dose of ipilimumab, despite daily administration of systemic corticosteroids to manage drug-induced AEs. The ongoing clinical response is maintained without any further antineoplastic treatment.

Background: Mastocytosis is a disorder characterized by the accumulation of mast cells in various organs, most commonly in the skin. Cutaneous mastocytosis (CM) can be classified as nodular CM with solitary or multiple lesions, diffuse CM (erythroderma), and maculopapular CM including the papular/plaque variant, urticaria pigmentosa (UP) and telangiectasia macularis eruptiva perstans (TMEP). Objective: To evaluate the dermatoscopic features of cutaneous mastocytosis. Methods: We reviewed the dermatoscopic images of 6 patients who had different variants of cutaneous mastocytosis and who attended the Departments of Dermatology at the Medical University of Ankara, Turkey, and the Medical University of Vienna, Austria. Results: In UP and in the papular variant of CM the most common structures seen by dermatoscopy were brown reticular lines (pigment network). In TMEP we observed telangiectatic vessels arranged in a reticular pattern. Conclusion: Skin lesions of mastocytosis may exhibit a pigment network, a dermatoscopic feature said to be characteristic of melanocytic lesions. We were also able to identify a new dermatoscopic feature, a reticular vascular pattern that is characteristic of a clinical variant of mastocytosis known as TMEP. This feature may help to differentiate TMEP from other variants of mastocytosis and from other exanthematous skin diseases.