Recurrence
Melanoma recurred in two patients following initial therapy with WLE,
one at Stage III and one at Stage 0. Both had a family history of
melanoma. One patient was diagnosed with melanoma in situ on the left
thumb. Biopsy showed positive margins and the initial SLNB was positive.
Upon recurrence, the patient underwent repeat excision with positive
margins and SLNB that was negative. The other patient diagnosed at Stage
IIIc had a history of sunburns and presented for a newly growing
“mole” on the right preauricular cheek. Skin biopsy revealed a
non-ulcerated superficial spreading melanoma with Breslow thickness of 2
mm and positive margins. SLNB was positive. BRAF mutation was
negative. Treatment at recurrence included radiation, complete neck
dissection (levels I-V), parotidectomy, as well as ipilimumab,
nivolumab, and pembrolizumab. After the last dose of nivolumab, the
patient experienced symptoms of checkpoint colitis, however colonoscopy
was negative, and the patient’s condition subsequently improved with
steroids.