Treatment of malignant melanoma with dacarbazin (DTIC-DOME) with special reference to urinary excretion of 5-S-cysteinyldopa

Neurocutaneous Melanosis Associated With Malignant Leptomeningeal Melanoma in an Adult: Clinical Significance of 5-S-Cysteinyldopa in the Cerebrospinal Fluid -Case Report-

A 35-year-old male presented with a variant of neurocutaneous melanosis with leptomeningeal malignant melanoma. He had three pigmented nevi from birth. He suffered diplopia followed by headache. T1-weighted magnetic resonance (MR) imaging revealed hydrocephalus and a small linear hyperintense lesion in the right frontal cortex. Several parts of the cortical sulci and the brain surface were slightly enhanced by gadolinium. Ventriculoperitoneal shunting was performed and extensive pigmented leptomeninges were recognized. Open biopsy established the diagnosis of leptomeningeal malignant melanoma. Combined chemoimmunotherapy was repeated every other month with monitoring of the 5-S-cysteinyldopa (5-S-CD) level in the cerebrospinal fluid (CSF). The 5-S-CD level decreased after each treatment, but the basal level steadily increased prior to the next treatment. Two years after the onset, he showed paraplegia caused by an extramedullary mass at the T-6 level. MR imaging showed that melanoma had involved the entire subarachnoid space including the whole spine. He underwent emergent removal of the spinal tumor and showed transient marked improvement. Further intensive chemotherapy was given. However, he died 31 months after the onset of massive proliferation of intracranial leptomeningeal melanoma. Measurement of CSF 5-S-CD levels is valuable for evaluating the therapeutic efficacy and for monitoring the progression of melanoma.

Eumelanin-related indolic compounds in the urine of treated melanoma patients

A method was developed for the quantitation of six eumelanin-related indolic compounds in urine. The procedure employs methane ionization of the hexafluoroisopropyl and/or pentafluoropropionyl derivatives of 5,6-dihydroxyindole, 5-hydroxy-6-methoxyindole, 6-hydroxy-5-methoxyindole, 5-hydroxy-6-methoxyindolyl-2-carboxylic acid, 6-hydroxy-5-methoxyindolyl-2-carboxylic acid and 5,6-dimethoxyindolyl-2-carboxylic acid together with their deuterated analogues, and selected ion-monitoring. Deuterated analogues are added as internal standards to enzymatically hydrolysed urine before diethyl ether extraction. The method was used for monitoring urinary excretion in patients with malignant melanoma treated with cytostatics. In several cases, a decrease of the excretion of the eumelanin-related substances was recorded after the therapy. The usefulness of the individual indolic compounds for such follow-up studies is discussed.

Elevated gamma-glutamyl transpeptidase levels in malignant melanoma

Serum gamma(glutamyl) transpeptidase (GGTP) levels were measured in fifty patients with malignant melanoma to determine whether the enzyme was a sensitive indicator of disease status. Patients were divided into three groups based on clinical stage. Eighteen patients, following complete surgical resection of their primary disease, had a mean GGTP value of 10.97 International Units/Liter, which was not significantly different from the mean of healthy controls (10.2 +/- 2.5; range, 5.56--15.2). Likewise, eight patients who had undergone resection of regional disease or solitary metastasis had values near the upper range for controls. Serial testing in 15 of the above patients revealed no significant fluctuations on a daily or monthly basis. In contrast, individuals with metastatic disease had significantly elevated GGTP levels and demonstrated stepwise increases with disease progression. In seven patients enzyme levels were predictive of either recurrent disease or response to therapy. We conclude that serum GGTP levels are a useful test in monitoring clinical status of melanoma patients.