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Bordeanu-Diaconescu EM, Cretu A, Grosu-Bularda A, Andrei MC, Hodea FV, Dumitru CS, Enache V, Creanga CA, Lascar I, Hariga CS. Comprehensive Literature Review on Melanoma of Unknown Primary Site Triggered by an Intriguing Case Report. Diagnostics (Basel) 2024; 14:2210. [PMID: 39410614 PMCID: PMC11475773 DOI: 10.3390/diagnostics14192210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/20/2024] [Accepted: 09/30/2024] [Indexed: 10/20/2024] Open
Abstract
Melanoma is one of the most aggressive forms of skin cancer. While most melanomas have a discernible primary site, a small subset, approximately 3.2%, present as a metastatic disease without an identifiable primary origin, a condition known as melanoma of unknown primary (MUP). Unusual cases of primary melanoma have also been previously reported in the respiratory, gastrointestinal, and urogenital tracts. MUP typically is found in lymph nodes, subcutaneous sites, and visceral organs, with hypotheses about its origin including spontaneous primary tumor regression and ectopic melanocytes. MUP presents unique challenges in diagnosis and treatment due to the absence of a detectable primary tumor. Understanding its genetic and molecular features, epidemiology, prognostic factors, and treatment options is crucial for optimizing patient care and outcomes in this subset of melanoma patients. We conducted an extensive literature review triggered by a case report of a patient with suspected MUP. A 51-year-old woman was transferred from another hospital where an incision was performed for a suspected superinfected hematoma of the left thigh. Since the patient showed high leukocytosis and redness and swelling of the thigh, local debridement, drainage, and excisional biopsy of the tumor mass were performed in our unit in the emergency setting, and the tumor was taken for histopathology evaluation. Intraoperatively, the mass appeared nonspecific. The permanent histopathology report established a diagnosis of melanoma, with tumor proliferation also involving lymphoid tissue, and despite broad clinical and imagistic assessments, the primary melanoma could not be identified. Clinicians must be aware of the varied clinical manifestations of malignant melanoma, especially in cases of occult melanoma where the primary site is not evident.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andrei Cretu
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Andreea Grosu-Bularda
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Florin-Vlad Hodea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Catalina-Stefania Dumitru
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Valentin Enache
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cosmin-Antoniu Creanga
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
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Shah N, Jacob J, Househ Z, Shiner E, Baird L, Soudy H. Unchecked immunity: a unique case of sequential immune-related adverse events with Pembrolizumab. J Immunother Cancer 2019; 7:247. [PMID: 31511075 PMCID: PMC6740018 DOI: 10.1186/s40425-019-0727-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibition has dramatically transformed the treatment of malignant melanoma. With increasing use, their unique spectrum of immune-mediated toxicity has become apparent. CASE PRESENTATION We describe a case of sequential immune-related adverse events (irAEs) in a patient with metastatic melanoma treated with single-agent anti-programmed cell death-1 (PD-1) therapy, pembrolizumab. Although numerous cases of irAEs have been reported, sequential multi-organ involvement, including progressive atopic dermatitis, vitiligo, autoimmune nephritis, autoimmune hepatitis, and autoimmune encephalitis after cessation of therapy, has not been previously documented. CONCLUSIONS Immunosuppression resulted in clinical remission of each irAE, highlighting the importance of vigilance for autoimmune complications in patients treated with checkpoint inhibition, even after immunotherapy cessation.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Agents, Immunological/adverse effects
- Dermatitis, Atopic/chemically induced
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/pathology
- Encephalitis/chemically induced
- Encephalitis/drug therapy
- Encephalitis/pathology
- Hepatitis, Autoimmune/drug therapy
- Hepatitis, Autoimmune/etiology
- Hepatitis, Autoimmune/pathology
- Humans
- Immunotherapy/adverse effects
- Male
- Melanoma/drug therapy
- Melanoma/immunology
- Melanoma/secondary
- Nephritis, Interstitial/chemically induced
- Nephritis, Interstitial/drug therapy
- Nephritis, Interstitial/pathology
- Prognosis
- Vitiligo/chemically induced
- Vitiligo/drug therapy
- Vitiligo/pathology
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Affiliation(s)
- N Shah
- St George-Sutherland Basic Physician Training Network, Kogarah, New South Wales, Australia.
| | - J Jacob
- St George-Sutherland Basic Physician Training Network, Kogarah, New South Wales, Australia
| | - Z Househ
- Department of Anatomical Pathology, SEALS, St George Hospital, Kogarah, New South Wales, Australia
| | - E Shiner
- Department of Neurology, St George Hospital, Kogarah, New South Wales, Australia
| | - L Baird
- Department of Aged Care, St George Hospital, Kogarah, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - H Soudy
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, Australia
- Department of Medical Oncology, The Sutherland Hospital, Caringbah, New South Wales, Australia
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