Evaluation of the response of unresectable primary cutaneous melanoma to immunotherapy visualized with reflectance confocal microscopy: A report of 2 cases Journal Article


Authors: Navarrete-Dechent, C.; Cordova, M.; Postow, M. A.; Pulitzer, M.; Lezcano, C.; Halpern, A. C.; Rossi, A. M.
Article Title: Evaluation of the response of unresectable primary cutaneous melanoma to immunotherapy visualized with reflectance confocal microscopy: A report of 2 cases
Abstract: Importance: Melanoma incidence and the use of systemic treatments for it are rising. Current treatment monitoring uses clinical examination and radiologic examinations; however, cutaneous involvement and cutaneous metastasis may not be well visualized. Reflectance confocal microscopy (RCM) is a US Food and Drug Administration-approved, noninvasive technology that enables visualization of the skin with quasihistological resolution. Objective: To evaluate the feasibility of using RCM to monitor advanced melanomas treated with immunotherapy. Design, Setting, and Participants: This case report study took place from March 2017 to June 2018 and included 2 patients with locally advanced melanoma who were not candidates for surgery or were not willing to have surgery and who were started on an immunotherapy regimen at a tertiary care cancer hospital. Main Outcomes and Measures: Clinical and RCM findings correlated with histopathology. Results: In the patients, locally advanced melanoma with cutaneous involvement was treated with immunotherapy (pembrolizumab in 1 patient and an ipilimumab-nivolumab combination in the other) with resulting clearance of the lesions. Use of RCM showed the disappearance of clear melanoma features seen at baseline; these findings correlated with histopathology. The response was not seen with radiologic images, such as magnetic resonance imaging and computed tomography. Conclusions and Relevance: Although RCM will not replace larger field imaging (such as magnetic resonance imaging, positron emission tomography, and computed tomography) in the management and follow-up of melanoma or other tumors, for imaging of cutaneous involvement and disease monitoring, RCM holds promise as a novel noninvasive technique. © 2019 American Medical Association. All rights reserved.
Journal Title: JAMA Dermatology
Volume: 155
Issue: 3
ISSN: 2168-6068
Publisher: American Medical Association  
Date Published: 2019-03-01
Start Page: 347
End Page: 352
Language: English
DOI: 10.1001/jamadermatol.2018.3688
PROVIDER: scopus
PUBMED: 30624578
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Allan C Halpern
    303 Halpern
  2. Melissa P Pulitzer
    130 Pulitzer
  3. Michael Andrew Postow
    187 Postow
  4. Anthony Rossi
    91 Rossi
  5. Miguel A Cordova
    43 Cordova