Immediate Local and Regional Recurrence After the Excision of a Polypoid Melanoma: Tumor Dormancy or Tumor Activation?

Abstract

Recurrent melanoma occurs in approximately one third of the patients who are treated for cutaneous melanoma. Although the majority of recurrences occur within the first few years of primary therapy, a significant number remain at risk beyond 10 years. Tumor dormancy provides the conceptual framework to explain a prolonged quiescent state in which tumor cells are present, but tumor progression is not clinically apparent. Surgery, or other perturbing factors, might modulate the transition of dormant cancer cells to rapidly growing ones. These may be due to a perturbation of the mechanisms of tumor regulation such as local immunity or angiogenesis. Here, the case of a woman is discussed in whom the surgical removal of a polypoid melanoma was followed, in less than a month, by local recurrence and locoregional lymph nodal metastases, which were previously clinically absent.

Acral lentiginous melanoma treated with topical imiquimod cream: possible cooperation between drug and tumour cells

“…Another possible explanation might be the effect of ‘tumour dormancy’, where tumours grow very slowly because of a balance between the neoplasia and the immune (and nonimmune) mechanisms of tumour control. In another paper by our group, we speculate that the tumour could work as a sort of ‘booster vaccine’, constantly providing a certain level of tumour antigens and maintaining the immune system in a state of alertness and reactivity against the tumour itself. Melanoma is one of the few cancers that can be recognized by the immune system.…”

Natural Course of Untreated Cutaneous Melanoma

“…In contrast, there are some reports in the literature describing a rapid ''explosion'' of metastases after tumor surgery. 1,2 Different reasons for a potential surgically induced tumor growth have been discussed. One explanation could be that surgery may lead to an increase of circulating tumor cells and surgical stress causes a disturbance of the antitumor immune response.…”

“…Occasional spontaneous regressions of malignant melanomas show the impact of the immune response on tumor growth. In contrast, there are some reports in the literature describing a rapid “explosion” of metastases after tumor surgery 1,2 . Different reasons for a potential surgically induced tumor growth have been discussed.…”

Parasite Subsistence of Human Cancer

“…Excision of primary melanomas precipitated the appearance of new subunits in three skin cancer patients. De Giorgi et al [53], Tseng et al [54]. In one case of pancreatic cancer, excision of the primary adenocarcinoma caused the appearance in the liver of numerous previously undetectable subunits Deylgat et al [55].…”