Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report

Abstract

Patient: Female, 59-year-old Final Diagnosis: Melanoma malignant • mucosal melanoma Symptoms: Cough • hemoptysis • weigh loss Medication: — Clinical Procedure: Lymph node excision • pulmonary bilobectomy Specialty: Oncology • Surgery Objective: Rare disease Background: Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. Case Report: We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. Conclusions: Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

A Case of Primary Malignant Melanoma of the Lung with BRAF V600E Mutation and Distinctive Bronchoscopic Features

“…Dabrafenib and trametinib are commonly used to treat patients with BRAF V600E mutated malignant melanoma of the skin [7]. Two out of three patients with BRAF V600E mutated PMML were treated with this combination therapy [3,5,6]. In our case, the patient showed disease control for approximately 2 years, indicating that this combination treatment was effective for BRAF V600E mutated PMML.…”

“…However, the incidence of genetic alterations in PMML remains unclear because of its rarity. To date, there have been only 13 reports of genetic analyses in PMML tumors, in which only 3 tumors (23%) have been reported to be BRAF-mutated [3,5,6].…”

Right upper lobectomy after immunotherapy for primary malignant melanoma of the lung: a case report and literature review

“…The concurrent use of ipilimumab and nivolumab has manageable safety profiles and produced clinical data different from published monotherapy activity, achieving rapid and profound tumor regression ( 18 ). A study has also demonstrated the efficacy of post-operative surgery and the ability of anti-PD1 (pembrolizumab) to shrink mucosal melanoma to a size that allows for resection ( 19 ). The size of PMML decreased from 54 mm × 50 mm to 16 mm × 10 mm, a size that could be surgically removed.…”

CT and PET/CT findings of primary pulmonary malignant melanoma: a case report and literature review

“…A small number of patients have been reported with a better prognosis. Bernal et al 15 reported a case of unresectable PMML with clinical stage IIIB (T4N2M0) disease. The patient obtained a partial response to pembrolizumab and underwent radical surgery.…”