Case Q (Status: alive and disease-free; survival: 9 years)
A 54-year-old Caucasian male initially presented with neurological symptoms in December of 2004, and underwent resection of hemorrhagic right frontal cerebral melanoma metastasis of unknown primary site. Adjuvant whole-brain radiotherapy was given. Shortly thereafter, he presented for resection of a left lower back subcutaneous metastatic deposit. He remained disease-free until October 2005, when he was noted to have a low hemoglobin level, and upper and lower endoscopies revealed no cause for this. A small bowel capsule camera study demonstrated a nonobstructing bleeding mass in the lower small intestine. He was also noted to have a mass in the right inguinal region, for which he underwent a right radical inguinal and pelvic lymph node dissection in December 2005. In February 2006, a small bowel resection and primary anastomosis removed the two previously noted metastatic melanoma deposits. He has had no further recurrence of melanoma.
Case R (Status: alive and disease-free; survival: 6 years)
An 83-year-old male presented in May 2007 with a Clark level V, Breslow 3.95 mm melanoma of the scalp, with perineural invasion. Multiple extensive satellite lesions developed covering half of his scalp, and they were treated by extensive wide excision and grafting, with adjuvant radiotherapy. In February 2009, the patient re-presented with a second primary Clark level IV, Breslow 0.85 mm thick metastasis to his right thigh, which was surgically excised.
For the purposes of comparison, the reported relevant clinical outcome measures for a range of different published treatment modalities for metastatic melanoma are shown in Table 2.
(To view a larger version of Table 2, click here.)