Bari Omar, Cohen Philip R
School of Medicine, University of California, San Diego.
Department of Dermatology, University of California, San Diego.
Cureus. 2017 Feb 13;9(2):e1026. doi: 10.7759/cureus.1026.
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.
肿瘤性黑变病是一种完全消退的黑色素瘤形式，通常表现为色素沉着较深的病变，疑似恶性黑色素瘤。组织学检查显示真皮和皮下有密集的噬黑素细胞浸润。帕博利珠单抗是一种针对程序性死亡受体-1（PD1）的抗体，是晚期黑色素瘤的一线治疗药物。本文描述了一名81岁患有转移性黑色素瘤的男性患者，在接受帕博利珠单抗治疗后，先前转移部位出现了肿瘤性黑变病。通过在PubMed数据库中检索关键词：抗体、免疫疗法、黑色素瘤、黑变病、转移、帕博利珠单抗和肿瘤，对检索出的论文及其参考文献进行了综述。该患者最初于三年前被诊断为左侧脸颊的恶性雀斑样痣黑色素瘤，并接受了广泛局部切除治疗。14个月后，患者随后被诊断为左侧顶叶头皮的亲表皮转移性恶性黑色素瘤，并接受了广泛局部切除治疗。三个月后，患者在头皮同一区域被发现有转移性黑色素瘤，并开始接受帕博利珠单抗免疫治疗。九个月后，患者在先前转移部位被诊断为肿瘤性黑变病。开始使用帕博利珠单抗治疗13个月后，患者仍无疾病复发。肿瘤性黑变病可能会模仿恶性黑色素瘤；因此，应进行包括皮肤活检在内的检查。已有使用伊匹单抗后出现广泛肿瘤性黑变病的报道，我们在此补充一例使用帕博利珠单抗治疗后的病例。由于免疫疗法已成为晚期黑色素瘤的一线治疗方法，可能会出现更多肿瘤性黑变病的病例。
