Tumoral Melanosis Nine Years After Wide Local Excision of a Thin Melanoma

Kieran, Ingrid; Mowatt, David; Gajanan, Kantappa; Shenjere, Patrick; Kosutic, Damir

doi:10.1097/dss.0000000000000710

Cited by 2 publications

(4 citation statements)

References 2 publications

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“…Clinically, tumoral melanosis typically presents as blue, black, or purple macules, papules, patches, and nodules highly suspicious for primary melanoma or cutaneous metastases. [1][2][3][4][5][6][7][8][9][10][11][12][13]15 The Garrido et al 14 report was unique in that the tumoral melanosis presented as an erythematous, scaly plaque on the upper trunk. Because tumoral melanosis and melanoma cannot be distinguished clinically, histopathology along with the clinical history is essential to establish the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Tumoral melanosis represents a rare presentation of completely regressed melanoma with only 18 cases reported to date. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] There is limited guidance in the literature regarding diagnostic criteria for tumoral melanosis, and it is difficult to distinguish from partial regression.…”

Section: Introductionmentioning

confidence: 99%

“…Typically, histopathology of tumoral melanosis demonstrates a large, nodular collection of melanin-laden macrophages and melanin pigment in the dermis and/or subcutaneous tissue in the absence of melanocytes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Alternatively, regression typically displays additional features of fibrosis, lymphocytic inflammation, remaining viable melanocytes, and in some cases, a prior history of preceding melanocytic lesion. [16][17][18][19][20][21][22] Most recently, tumoral melanosis has been described in the context of immunotherapy with ipilimumab (a monoclonal antibody targeting CTLA-4) as well as nivolumab and pembrolizumab (humanized monoclonal antibodies against programmed death 1 receptor) and has been believed to be associated with improved prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma—A Single Institutional Experience and Literature Review

Jurgens¹,

Guru

Guo

et al. 2020

The American Journal of Dermatopathology

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Background: Tumoral melanosis clinically resembles metastatic melanoma, occurs in the context of regressed disease, and requires evaluation to rule out underlying melanoma and metastatic disease. Histopathology demonstrates a nodular infiltrate of melanophages in the dermis, subcutaneous tissue, deep soft tissue, or lymph nodes in the absence of viable melanocytes. Recent limited reports of tumoral melanosis in the context of immunotherapy with ipilimumab (monoclonal antibody targeting CTLA-4) as well as nivolumab and pembrolizumab (humanized monoclonal antibodies against programmed death 1 receptor) highlight a unique presentation representative of treatment-related tumor regression and an association with a favorable clinical response.Objective: To describe our experience with tumoral melanosis in the setting of immunotherapy for metastatic melanoma and elucidate the clinical and histopathological features.Methods: Retrospective case series from a single tertiary care institution. Results:We describe 10 cases of patients with metastatic melanoma who received treatment with immunotherapy before the development of tumoral melanosis. Length of time between the initiation of therapy and the onset of tumoral melanosis ranged from 2 to 20 months with a mean time of 10 months. At the end of the follow-up period, 8 patients were classified as having a complete or partial response to treatment with immunotherapy. One patient had progression of visceral and cutaneous disease on ipilimumab despite developing tumoral melanosis, and 1 patient had yet to undergo repeat imaging. Furthermore, at the end of follow-up, 3 patients were alive with no evidence of active disease, 5 patients were alive with disease, and 1 patient was deceased, although this patient died of a cardiovascular event unrelated to his underlying melanoma. Of the patients who were classified as alive with disease, 2 patients had minimal remaining disease, and 2 patients had an almost complete response on immunotherapy with recurrence of visceral metastases after immunotherapy was discontinued. One patient developed new peritoneal and cutaneous metastases on pembrolizumab despite development of tumoral melanosis. Conclusions:The underlying biologic mechanisms and prognostic implications of tumoral melanosis in the setting of immunotherapy remain to be elucidated. Further prospective studies with a larger cohort and prolonged follow-up are necessary to better understand the incidence, prevalence, and oncologic outcomes in patients with tumoral melanosis who receive immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma—A Single Institutional Experience and Literature Review

Jurgens¹,

Guru

Guo

et al. 2020

The American Journal of Dermatopathology

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“…Melanophages may extend to lymph nodes [4-5]. These melanin-laden macrophages stain positive for CD68 and negative for HMB45, Melan A, S100, and SOX10 [4,8]. …”

Section: Discussionmentioning

confidence: 99%

Tumoral Melanosis Associated with Pembrolizumab-Treated Metastatic Melanoma

Bari

Cohen

2017

Cureus

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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.

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Tumoral Melanosis Nine Years After Wide Local Excision of a Thin Melanoma

Cited by 2 publications

References 2 publications

Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma—A Single Institutional Experience and Literature Review

Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma—A Single Institutional Experience and Literature Review

Tumoral Melanosis Associated with Pembrolizumab-Treated Metastatic Melanoma

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