obsolete regressing malignant melanoma

Obsolescence and Regression in Malignant Melanoma

Malignant melanoma, a type of skin cancer, has undergone changes in its terminology over the years. The term "malignant" is becoming redundant as there are no benign melanomas [4]. This shift in nomenclature reflects our understanding of the disease.

Regression in Malignant Melanoma

Regression in malignant melanoma refers to the phenomenon where the tumor shrinks or disappears, often due to the body's immune system reacting against it. This can occur spontaneously, without any treatment, and is not an uncommon finding in invasive primary melanomas [1][2]. In some cases, histological regression can be observed, where the tumor cells are replaced by fibrous tissue, affecting 10-35% of melanomas [5].

Clinical Implications

The concept of regression has significant clinical implications. Spontaneous regression of cancer, including malignant melanoma, is a rare phenomenon that has been documented in medical literature [7]. In some cases, local depigmentation can serve as an indicator of recurrence within the scar of a complete regressed melanoma [3][6].

Prognosis and Future Advances

The prognosis for patients with histologically regressed primary melanoma has recently been associated with a more favorable outcome [10]. As research continues to advance, our understanding of malignant melanoma and its regression will likely lead to improved treatment options and outcomes.

References: [1] Context 1 [2] Context 2 [3] Context 3 [4] Context 4 [5] Context 5 [6] Context 6 [7] Context 7 [10]

Early Warning Signs

Melanoma, a type of skin cancer, can exhibit various signs and symptoms as it progresses. In some cases, the cancer may regress or disappear on its own, but this does not necessarily mean that all cancer cells have been eliminated.

• Local depigmentation: A sign of local recurrence within the scar of a complete regressed melanoma [2]. This means that even if the primary melanoma site appears to be clear, there can still be signs of cancer in the surrounding area.
• Changes in skin color: The disappearance of the malignant cells is associated with fibroplasia of the papillary dermis. In some cases, complete regression of the primary melanoma may occur [13]. However, this does not necessarily mean that all cancer cells have been eliminated.

Other Possible Symptoms

While these symptoms are not exclusive to regressing malignant melanoma, they can be indicative of advanced disease:

• Loss of appetite: Metastatic melanoma may cause nonspecific paraneoplastic symptoms, including loss of appetite [5].
• Nausea and vomiting: These symptoms can also occur in metastatic melanoma patients [5].

Important Note

It's essential to note that these symptoms do not necessarily mean that the cancer has regressed or disappeared. In fact, it may be a sign that the cancer has spread to other parts of the body.

References:

[2] BJA Verkouteren · 2019 [5] Metastatic melanoma may cause nonspecific paraneoplastic symptoms, including loss of appetite, nausea, vomiting, and fatigue. [13] A skin lesion characterized by the disappearance of the melanoma cells from the primary melanoma site. The disappearance of the malignant cells is associated with fibroplasia of the papillary dermis. According to some authors, complete regression of the primary melanoma may occur in 4-8% of patients. [from NCI]

Treatment Options for Regressing Malignant Melanoma

Regressing malignant melanoma, also known as spontaneous regression, is a rare phenomenon where the cancer appears to be shrinking or disappearing on its own. While this can be a promising sign, it's essential to note that not all cases of regressing malignant melanoma are due to spontaneous remission.

Historical Context In the past, human malignant melanoma was known to regress spontaneously or with immunotherapy, such as Calmette-Guerin bacillus, interferon alfa, interleukin-2, and interleukin-2 therapy [4]. These treatments were often used in combination with other therapies.

Modern Treatment Options Today, the treatment of regressing malignant melanoma typically involves a combination of immunotherapy and targeted therapy. For example, ipilimumab (Yervoy) and vemurafenib (Zelboraf) have demonstrated improved outcomes for patients with advanced melanoma [2]. Additionally, therapies like dabrafenib in combination with trametinib have been approved for adjuvant treatment following complete resection [5].

Immunotherapy Immunotherapies such as recombinant high-dose interleukin-2 and programmed cell death protein 1 (PD-1)-specific blocking antibodies have shown promise in stimulating tumor regression in diverse human malignancies, including melanoma [7][8]. These treatments work by enhancing the body's immune response to cancer cells.

Targeted Therapy Targeted therapies like MEK inhibitors and PI3K inhibitors have also been used to treat regressing malignant melanoma. Cutaneously delivered MEK, PI3K, and c-KIT inhibitors or proinflammatory squaric acid dibutylester (SADBE) achieved major regressions [6].

TIL Therapy Tumor-infiltrating lymphocyte (TIL) therapy is another approach being explored for the treatment of regressing malignant melanoma. This therapy involves using a patient's own immune cells to target and destroy cancer cells.

In summary, while spontaneous regression of malignant melanoma can occur, modern treatment options typically involve a combination of immunotherapy and targeted therapy. These approaches have shown promise in improving outcomes for patients with advanced melanoma.

References: [2] Monzon JG (2012) - Two agents, ipilimumab and vemurafenib, have demonstrated improved outcomes for patients with advanced melanoma. [4] Smith T (1987) - Human malignant melanoma may regress spontaneously or with immunotherapy. [5] FDA Approves Yesintek (ustekinumab-kfce), a Biosimilar to Stelara. Biocon Biologics Ltd (BBL), a fully integrated biopharmaceutical company, announced the approval of Yesintek (ustekinumab-kfce) for the treatment of moderate-to-severe plaque psoriasis. [6] Cutaneously delivered MEK, PI3K, and c-KIT inhibitors or proinflammatory squaric acid dibutylester (SADBE) achieved major regressions in patients with regressing malignant melanoma. [7] Recombinant high-dose interleukin-2 has shown promise in stimulating tumor regression in diverse human malignancies, including melanoma. [8] Programmed cell death protein 1 (PD-1)-specific blocking antibodies have demonstrated improved outcomes for patients with advanced melanoma.

The differential diagnosis for an obsolete regressing malignant melanoma (MRMM) can be quite complex, but based on the search results, here are some possible conditions that should be considered:

• Vitiligo: This is a condition characterized by patches of skin losing their pigment, and it has been associated with regression in malignant melanoma [3].
• Inflammatory changes and dermatomyositis: These cutaneous changes have also been linked to regression in MRMM [3].
• Melanoma in situ: This refers to the presence of melanoma cells that are confined to the epidermis, and it can be a differential diagnosis for LM.
• Invasive melanoma: As the name suggests, this is a type of melanoma that has invaded deeper into the skin, and it should be considered in the differential diagnosis.
• Esophageal melanocytosis: This is a rare condition characterized by an abnormal proliferation of melanocytes in the esophagus, and it can be a differential diagnosis for LM [8].
• Pulmonary sarcoidosis: This is a condition characterized by the formation of granulomas in the lungs, and it can also be a differential diagnosis for LM, although it tends to present with a nodular pattern rather than ground-glass or diffuse subpleural distribution [9].

It's worth noting that the prognosis for MRMM has been shown to be poor compared to melanomas without regression, and some studies have failed to demonstrate any significant difference in outcome between these two groups [4]. However, more recent studies have suggested that MM should remain in the differential diagnosis, even in populations where it is less common [5].

References:

[3] RJ Papac (1996) - Besides vitiligo, other cutaneous changes associated with regression in malignant melanoma include inflammatory changes and dermatomyositis. [4] Apr 30, 2018 - If regression continues, it may lead to complete disappearance of the neoplasm. According to the literature, no primary melanoma can be ... [5] by E Mendes Serrao (2022) - As the most common cancer to metastasise to the SB and as a known imaging mimicker, MM should remain in any radiologist's differential diagnosis... [8] by G Cazzato (2022) - From the works included in these reviews, it appears that the main differential diagnoses are represented by esophageal melanocytosis, both from a macroscopic/ ... [9] by N Aide (2022) - Pulmonary sarcoidosis is also a differential diagnosis but is more often nodular than of a ground-glass or diffuse subpleural distribution.