A Clinical, Histologic And Immunologic Study Of A Case Of Metastatic Malignant Melanoma Undergoing Spontaneous Remission
Cancer 37(2): Feb 1976; 735-742
View Original Source →Abstract
A patient with biopsy-proven dermal recurrent malignant melanoma who refused therapy, and who was observed to undergo clinical regression during the period of November 1972 through June 1974, was studied to define the histologic features of spontaneous remission, and to evaluate the immune response as measured by in-vitro assays of lymphocyte cytotoxicity and serum effects during the course of regression. Biopsy of regressed areas showed an absence of malignant melanoma cells in basal layers of epidermis with relative increase in basal layer clear cells; dermal inflammatory reaction with lymphocytic infiltrate, melanophages, and degenerate malignant melanocytes; and dermal reactive vascular proliferation and interstitial edema progressing to reparative dermal fibrosis. Using a microcytotoxicity assay with two established allogeneic melanoma cell cultures as target cells, a statistically significant (p < 0.01) increase in lymphocyte cytotoxicity values was observed over the clinical time course of regression. No significant serum cytotoxic or serum blocking effects were detectable. These findings are consistent with an immunologic basis for the spontaneous remission of the dermal melanoma metastases present in this patient.
Case Details
Personal Characteristics
74-year-old-white man, past medical history of a bleeding peptic ulcer managed conservatively in 1965, and benign prostatic hypertrophy treated surgically by a transurethral resection procedure in 1972
Clinical Characteristics
A mole on the left anterolateral chest wall in proximity to the nipple, local chest wall recurrence, satellitosis of the left anterior chest without palpable adenopathy, dermal metastatic melanoma with mononuclear infiltrate, lesions were flatter and less numerous, many had disappeared leaving a residual area of depigmentation
Remission Characteristics
Clinical regression during the period of november 1972 through june 1974, absence of malignant melanoma cells in basal layers of epidermis, dermal inflammatory reaction with lymphocytic infiltrate, melanophages, and degenerate malignant melanocytes, dermal reactive vascular proliferation and interstitial edema progressing to reparative dermal fibrosis, increase in lymphocyte cytotoxicity values over the clinical time course of regression
Treatment & Mechanisms
Proposed Remission Mechanisms
Immunologic basis for the spontaneous remission of the dermal melanoma metastases
Clinical Treatment
Local excision, biopsy of regressed areas, punch biopsy of the regressing area
Additional Notes
The patient refused any form of therapy. No significant serum cytotoxic or serum blocking effects were detectable. The patient gave no history of drug medication, viral type infection, febrile illness, or trauma to the area.