Roundtable Roundup: Skin Cancer

Source: Targeted Oncology, July 2023

In separate live, virtual events, Hussein A. Tawbi, MD, PhD; and Allison Betof Warner, MD, PhD, discuss potential treatment options for a patient with BRAF mutation–negative melanoma.

Case Summary

  • A 78-year-old man had a history of stage III melanoma.
  • Patient underwent surgical resection 12 years prior.
  • Lymph node dissection was positive for nodal involvement.
  • Patient declined complete lymph node dissection and adjuvant systemic therapy.
  • Patient remained active since his surgery and maintained regular follow-up.
  • On routine follow-up, the patient presented with moderate asthenia that limited his daily activities, without other relevant clinical symptoms.
  • ECOG performance status:
  • Physical examination was unremarkable.
  • Notable laboratory findings: lactate dehydrogenase (LDH) level of 380 IU/L (reference range, 110-240 IU/L)
  • A full-body CT scan revealed the presence of pulmonary and hepatic nodules but no evidence of brain metastases.
  • The patient underwent a core-needle biopsy of the largest hepatic lesion in segment IVb without any complications.
  • Pathology revealed metastatic melanoma.
  • Mutation testing was BRAF negative.

TAWBI:The decision-making here was reasonable and appropriate. Either of those regimens technically would be appropriate for this patient. I would probably say the patient’s high LDH is the biggest [factor]. I also recognize that as you start using a new combination more consistently…people’s perception of the combination changes as they became more familiar with it.