Gizzi Gianluca, Didona Dario, Thal Serge C, Scarsella Luca
Federazione Italiana Medici di Medicina Generale, Rome, Italy.
Rare Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy.
Case Rep Oncol Med. 2025 Jul 15;2025:6396505. doi: 10.1155/crom/6396505. eCollection 2025.
The synchronous occurrence of melanomas of varying histological types is an uncommon event, with reported incidences ranging from 0.2% to 8.6%. We present the case of a patient diagnosed with Stage IIB nodular melanoma and Stage IIIC epithelioid cell melanoma within a 3-month period. After surgical excision of both lesions, lymph node enlargement was observed in the obturator region, indicating metastatic spread. As a result, combined immunotherapy with nivolumab and ipilimumab was initiated. Nivolumab and ipilimumab were administered at doses of 1 and 3 mg/kg, respectively, every 3 weeks for a total of four doses. Thereafter, treatment was continued with nivolumab alone at a dose of 3 mg/kg every 2 weeks. The patient underwent three cycles of immunotherapy, initially combined with intravenous methylprednisolone, later transitioned to an oral regimen with dexamethasone. The patient initially demonstrated a favorable clinical response without adverse effects. However, after the third infusion, severe diarrhea developed, leading to daily fluid losses exceeding 8 L and associated hypokalemia. Therefore, methylprednisolone was administered intravenously (2 mg/kg/day). Additionally, the patient experienced a splenic infarction that resolved spontaneously without resulting in asplenia. At the most recent follow-up evaluation, no lymph node enlargement was detected, and surveillance continues at 3-month intervals. Although rare, the simultaneous emergence of melanomas at distinct anatomical sites underscores the necessity for increased patient vigilance and comprehensive clinical monitoring to facilitate early detection and timely intervention. Prompt initiation of targeted immunotherapy may improve patient prognosis and outcomes.
不同组织学类型的黑色素瘤同步发生是一种罕见事件，报告的发生率在0.2%至8.6%之间。我们报告一例患者，在3个月内被诊断为IIB期结节性黑色素瘤和IIIC期上皮样细胞黑色素瘤。在手术切除这两个病灶后，发现闭孔区域淋巴结肿大，提示有转移扩散。因此，开始使用纳武单抗和伊匹单抗联合免疫疗法。纳武单抗和伊匹单抗的给药剂量分别为1和3mg/kg，每3周一次，共给药四次。此后，继续单独使用纳武单抗，剂量为3mg/kg每2周一次。该患者接受了三个周期的免疫治疗，最初联合静脉注射甲泼尼龙，后来过渡到口服地塞米松方案。患者最初表现出良好的临床反应且无不良反应。然而在第三次输注后，出现严重腹泻，导致每日液体丢失超过8升并伴有低钾血症。因此，静脉注射甲泼尼龙（2mg/kg/天）。此外，患者发生了脾梗死，梗死灶自行消退，未导致无脾。在最近的随访评估中，未检测到淋巴结肿大，目前仍每3个月进行一次监测。尽管罕见，但不同解剖部位同时出现黑色素瘤凸显了提高患者警惕性和进行全面临床监测以促进早期发现和及时干预的必要性。及时启动靶向免疫治疗可能改善患者的预后和结局。
