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Spontaneous Regression Of Metastatic Malignant Melanoma

Mikhail & Gorsulowsky, 1986Melanoma

Journal of Dermatologic Surgery and Oncology 12: May 5 1986; 497-500

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Abstract

Spontaneous regression is a well-recognized phenomenon that affects malignant neoplasms. Malignant melanoma is known to undergo such a change. It may affect the primary lesion and be confirmed histologically or the primary lesion may pass unnoticed and metastasis occurs from an occult primary. Spontaneous regression less frequently affects metastatic melanoma. Metastasis from malignant melanoma to the gastrointestinal tract occurs frequently. It may occur without a known primary and is considered a primary intestinal tumor by some authors. A 55-year-old male patient who had melena and intussusception that proved to be due to malignant melanoma of the small intestine is described. History and close examination failed to show any evidence of a primary lesion. The diagnosis was made after a biopsy was performed on two lesions in the neck. This was followed by a palliative and incomplete resection of an involved ileal segment. The patient did not receive chemotherapy, radiotherapy, or immunotherapy. He is now alive 8 years after diagnosis without evidence of malignancy. This case represents spontaneous regression of malignant melanoma of the small intestine that is considered either a primary intestinal tumor or a metastatic tumor from an occult regressed primary. The latter assumption makes this case unique in that spontaneous regression occurred twice, once in the occult primary lesion and once in the intestinal metastases.

Case Details

Personal Characteristics

A 77-year-old woman

Clinical Characteristics

The primary lesion, a lentigo malignant melanoma of the face, recurred after excision and metastasized to the parotid and upper cervical lymph nodes, and to the lungs. The patient declined further therapy. There was no clinical or radiologic evidence of metastasis 1 year later.

Remission Characteristics

When seen in march 1980, about 12 months after the last excision, the lymph nodes had become nonpalpable, and the lesions in the lungs had cleared. The patient remained free of any signs or symptoms of melanoma until she expired from other causes in may 1985, about 6 years after the initial evaluation.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Mohs microscopically controlled surgery, fresh tissue technique was undertaken in june 1978 to ablate the lesion. A splitthickness autograft was used to cover the wound. In april 1979, 10 months after the initial excision, three new pigmented plaques had developed adjacent to the superior, anterior, and inferior margins of the graft. They were 0.5, 0.7, and 1.0 centimeters in size. Biopsies showed malignant melanoma, clark level ii, 0.2 millimeters thick. The parotid mass was excised and proved to be a lymph node with metastatic melanoma.

Non-Clinical Treatment

The patient declined further studies or therapy. She was then kept under periodic observation.