Resident Rounds Part III: Metastatic Melanoma Patient on Vemurafenib Develops Multiple Primary Cutaneous Melanomas

March 2015 | Volume 14 | Issue 3 | Features | 316 | Copyright © March 2015


Jeffrey Brackeen MD, Jordan Jamerson BS, and Amy Brackeen MD

Texas Tech University Health Sciences Center, Lubbock, TX

in play. Several trials investigating different immunologic and MAPK enzyme combination therapies show promise. One example is a study of dabrafenib, a selective BRAF inhibitor, and trametinib, a MEK inhibitor, showed improvement of combination therapy over BRAF monotherapy in overall survival as well as a decrease in the rate of cutaneous SCC development.8 This treatment combination was recently granted accelerated approval from the FDA.
Interestingly, in this case, a single patient developed 6 primary melanomas, as well as 2 atypical melanocytic proliferations and 9 dysplastic nevi over less than a year’s time after initiating vemurafenib with no significant skin findings in the preceding 11 years of routine skin exams. Although cSCCs and KAa are expected complications of vemurafenib therapy and frequent monitoring is recommended, this case helps highlight the importance of a high degree of suspicion for melanocytic lesions as well, of which there may be multiple. Photographs and dermoscopy may be helpful in evaluating new, changing, or suspicious lesions, especially since findings may be subtle.6

DISCLOSURES

None of the authors have a conflict of interest.

REFERENCES

  1. Korn E, Lui P, Lee S, et al. Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials.J Clin Oncol. 2008;26:527-534.
  2. Keating G. Vemurafenib: in unresectable or metastatic melanoma.BioDrugs. 2012;26:325-334.
  3. Sinha R, Edmonds K, Newton-Bishop J, et al. Cutaneous adverse events associated with vemurafenib in patients with metastatic melanoma: practical advice on diagnosis, prevention and management of the main treatment-related skin toxicities.British J of Derm. 2012;167:987-994.
  4. Oberholzer P, Kee D, Dziunycz P, et al. RAS Mutations Are Associated With the Development of Cutaneous Squamous Cell Tumors in Patients Treated With RAF Inhibitors.J Clin Oncol. 2012;30:316-321.
  5. Zimmer L, Hillen U, Livingstone E, et al. Atypical Melanocytic Proliferations and New Primary Melanomas in Patients With Advanced Melanoma Undergoing Selective BRAF Inhibition.J Clin Oncol. 2012;30:2375-2383.
  6. Dalle S, Poulalhon N, Thomas L. Vemurafenib in melanoma with BRAF V600E mutation.N Engl J Med. 2011;365:1448–1449.
  7. Chapman P, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364:2507–2516.

AUTHOR CORRESPONDENCE

Jeffrey Brackeen MDjeffrey.brackeen@ttuhsc.edu
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