Case I (Status: alive and disease-free; survival: 13 years)

A 49-year-old male presented in 1999 for WLE of a primary melanoma of his back, Clark level V, Breslow depth 10 mm, and left axillary clearance for metastases. Over the next year, the patient required several further excisions for multiple subcutaneous and chest wall metastases of his back, left axilla, and chest, and subsequently underwent radiotherapy to his left axilla in late 2000. Further multiple subcutaneous and chest wall metastases developed. The patient commenced VMCL vaccine in November of 2000 and demonstrated an excellent clinical response within three doses, with resolution of all subcutaneous metastases within 6 weeks.

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Case J (Status: alive and disease-free; survival: 14 years)

A 33-year-old Caucasian male initially presented in 1994 for WLE of a Clark level III, Breslow thickness 0.9 mm melanoma of his back. In early 1999, secondary deposits developed in the lymph nodes of the right axilla, for which right radical axillary clearance was performed. Further deep subcutaneous in-transit nodular recurrence at the edge of the right axillary lymph node basin required further surgical resection several months later. No further therapy was given. He has remained disease-free on CT scanning.

Case K (Status: alive and disease-free; survival: 15 years)

A 34-year-old Caucasian male presented with an amelanotic melanoma of his scalp, Breslow thickness 7 mm, in 1998, and underwent WLE and in-continuity modified radical left neck dissection for an overt 3 cm metastatic left midcervical lymph node mass. Pathology showed three of 12 lymph nodes to be involved with the melanoma with extranodal spread, and the patient subsequently underwent adjuvant local radiotherapy to the left neck. He remained well until December of 2006, when a CT scan revealed a secondary metastasis to his left lung, which was fully resected in 2007. He has remained disease-free on CT scanning.

Case L (Status: alive and disease-free; survival: 11 years)

A 51-year-old Caucasian male presented in 1995 for wide excision of a Clark level IV, 1.3 mm nodular melanoma of his back. He re-presented in April 2002 for resection of a further subcutaneous deposit of his lower back and underwent a left thoracotomy in July 2002 for resection of a pulmonary metastasis. In 2005, further CT scans revealed a new lesion in the left lower lobe of the lung, which was completely excised. He has since remained disease-free to clinical and CT follow-up.

Case M (Status: alive and disease-free; survival: 13 years)

A 48-year-old Caucasian male presented in 2000 with a 4 cm diameter right axillary lump present for 7 months with no primary melanoma site identified. A fine-needle biopsy confirmed metastatic melanoma and he was booked for a right radical axillary lymph node dissection, but this was deferred so the patient could attend the Sydney Olympic Games. On review 6 weeks later, the mass had markedly reduced in size. The mass continued to decrease in size without treatment, and a CT scan at that time showed no evidence of disease. On recent repeat CT scanning in 2010, no metastatic disease was evident, and clinically he continues to be disease-free.

Case N (Status: alive and disease-free; survival: 10 years)

A 56-year-old Caucasian female presented in early 1993 for WLE of a malignant melanoma of the left leg, Clark level II, Breslow thickness 0.4 mm. She re-presented 10 years later with locally recurrent nodules over the left leg that were excised, some incompletely due to difficulty of location. She developed further local metastases over her limb within the next 2 years. She subsequently underwent isolated limb infusion chemotherapy in April 2004, but developed further local metastases in July, which were excised. In August 2004, the patient commenced the VMCL melanoma vaccine, and in November underwent a second isolated limb infusion therapy procedure due to further local recurrences. Several further recurrences were excised in 2005, and in December 2005, she underwent a third isolated limb infusion chemotherapy, which led to significant ulceration of her skin. In July 2006, CT scans showed lymphadenopathy in the left groin, and fine-needle biopsy confirmed metastatic melanoma. Radical left pelvic and inguinal lymph node dissections were performed in August 2006. She has been maintained on VMCL therapy since, and has developed a complete clinical response with no evidence of disease present clinically or on serial CT scans to date.

Case O (Status: alive and disease-free; survival: 6 years)

A 79-year-old man presented in early May 2007 for WLE of a Clark level IV, Breslow thickness 5.1 mm amelanotic melanoma from his right forehead. Sentinel node biopsy demonstrated metastatic disease, and a subsequent right modified radical neck dissection and right parotidectomy were performed. He re-presented 1 year later with a single metastasis to his scalp, which was completely excised, and then again with further metastatic deposits in the left parotid gland, for which a left parotidectomy and left modified radical neck dissection were performed. In early 2009, the patient re-presented with an enlarged metastatic right axillary lymph node, for which he underwent right radical axillary dissection. In January 2011, WLE of a second primary in situ melanoma of his left cheek was performed. He has remained disease-free on clinical and CT scan criteria since.

Case P (Status: alive and disease-free; survival: 12 years)

A 71-year-old female presented in March 1999 for WLE of a Clark level IV, Breslow 1.53 mm melanoma of the left leg. She re-presented for WLE of in-transit recurrence in late 2000 and again in November 2001 with multiple local recurrences of the left leg, which were surgically excised. Further recurrences were treated using isolated limb infusion chemotherapy with a CR. Local recurrences again occurred throughout 2002 and she commenced the VMCL melanoma vaccine in March 2003. In April 2003, she developed left groin lymph node metastases and underwent radical dissection of the left groin and pelvis, followed by continuous VMCL vaccine therapy. She has remained disease-free by clinical and CT scan criteria to date.