Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA.
J Immunother Cancer. 2021 Oct;9(10). doi: 10.1136/jitc-2020-001219.
Mucosal melanomas constitute a subtype of melanoma with less effective treatments than cutaneous melanomas. We present a case of oral mucosal melanoma that recurred despite multiple resections and adjuvant temozolomide. Treatment with topical imiquimod combined with pembrolizumab achieved remission. A 56-year-old woman presented with a pigmented mass on her left anterior hard palate. Biopsy revealed malignant melanoma. The patient had resection with neck dissection with 3 months of adjuvant temozolomide due to positive margins. Malignant melanoma involving the hard palate recurred 1 year later requiring additional resection. Two years later, two additional pigmented lesions were found; further resections were deferred due to expected morbidity. Following 6 weeks of topical imiquimod treatment, the lesions shrunk significantly. Adjuvant pembrolizumab was added and complete histopathologic remission was observed in 6 months. The patient remained in remission for 4 years before new melanoma in situ was diagnosed, requiring five additional months of imiquimod. As of April 2021, there is no clinical evidence of melanoma. There are limited reports of oral melanoma treated with topical imiquimod. Here, imiquimod administered in combination with pembrolizumab achieved complete pathologic response.
黏膜黑色素瘤是一种黑色素瘤亚型，其治疗效果不如皮肤黑色素瘤。我们报告了一例口腔黏膜黑色素瘤病例，尽管多次切除和辅助替莫唑胺治疗，但仍复发。局部应用咪喹莫特联合 pembrolizumab 治疗后达到缓解。一名 56 岁女性因左上前硬腭出现色素性肿块就诊。活检显示恶性黑色素瘤。由于边缘阳性，患者接受了 3 个月辅助替莫唑胺的切除术和颈部清扫术。1 年后，硬腭受累的恶性黑色素瘤复发，需要进一步切除。2 年后，又发现了两个额外的色素病变；由于预期的发病率，进一步的切除术被推迟。局部咪喹莫特治疗 6 周后，病变明显缩小。加入辅助 pembrolizumab，6 个月后观察到完全组织病理学缓解。患者缓解 4 年后，新诊断为原位黑色素瘤，需要额外 5 个月的咪喹莫特治疗。截至 2021 年 4 月，无黑色素瘤临床证据。有有限的报道称口腔黑色素瘤用局部咪喹莫特治疗。在这里，咪喹莫特联合 pembrolizumab 治疗达到完全病理缓解。
