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A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy
Melanoma carries a high risk of brain metastasis. A small subset of metastatic melanomas, known as amelanotic melanomas, does not present black coloration, reflecting a lack of melanin pigmentation. Here, we report a case of B-Raf proto-oncogene (BRAF) V600E mutation associated with a metastatic bra...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Japan Neurosurgical Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101700/ https://www.ncbi.nlm.nih.gov/pubmed/37065875 http://dx.doi.org/10.2176/jns-nmc.2022-0227 |
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author | FUJITA, Juntaro TOMITA, Yusuke ICHIMURA, Koichi YAMASAKI, Rie NISHIGAKI, Shohei NITTA, Yuki INOUE, Yusuke SOTOME, Yuta KIDANI, Naoya MURAOKA, Kenichiro HIROTSUNE, Nobuyuki NISHINO, Shigeki |
author_facet | FUJITA, Juntaro TOMITA, Yusuke ICHIMURA, Koichi YAMASAKI, Rie NISHIGAKI, Shohei NITTA, Yuki INOUE, Yusuke SOTOME, Yuta KIDANI, Naoya MURAOKA, Kenichiro HIROTSUNE, Nobuyuki NISHINO, Shigeki |
author_sort | FUJITA, Juntaro |
collection | PubMed |
description | Melanoma carries a high risk of brain metastasis. A small subset of metastatic melanomas, known as amelanotic melanomas, does not present black coloration, reflecting a lack of melanin pigmentation. Here, we report a case of B-Raf proto-oncogene (BRAF) V600E mutation associated with a metastatic brain tumor caused by the amelanotic melanoma. A 60-year-old man was transferred to our department following acute onsets of left upper limb paralysis and convulsion. In the brain imaging, multiple lesions in the right frontal lobe and left basal ganglia were detected, and the presence of an enlarged left axillary lymph node was revealed. Consequently, we removed the right frontal lesion and performed a biopsy of the left axillary lymph node. Histological analysis of both specimens indicated an amelanotic melanoma, and genetic testing revealed a BRAF V600E mutation. The residual intracranial lesions were treated with stereotactic radiotherapy and molecular-targeted therapy, with dabrafenib and trametinib as the systemic treatment. Based on the Response Evaluation Criteria in Solid Tumors, we determined that the patient achieved complete remission (CR) under uninterrupted molecular-targeted therapy over a period of 10 months. After the temporary withdrawal of dabrafenib and trametinib to avoid hepatic dysfunction, a new intracranial lesion appeared. CR of this lesion was achieved following reinstatement of the two drugs. These results suggest that, under limited conditions, molecular-targeted therapy can produce a sustained response against the intracranial metastasis of melanoma, and the therapy with reduced dose is still effective against a recurrent case after cessation of the therapy due to the toxicity. |
format | Online Article Text |
id | pubmed-10101700 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The Japan Neurosurgical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-101017002023-04-14 A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy FUJITA, Juntaro TOMITA, Yusuke ICHIMURA, Koichi YAMASAKI, Rie NISHIGAKI, Shohei NITTA, Yuki INOUE, Yusuke SOTOME, Yuta KIDANI, Naoya MURAOKA, Kenichiro HIROTSUNE, Nobuyuki NISHINO, Shigeki NMC Case Rep J Case Report Melanoma carries a high risk of brain metastasis. A small subset of metastatic melanomas, known as amelanotic melanomas, does not present black coloration, reflecting a lack of melanin pigmentation. Here, we report a case of B-Raf proto-oncogene (BRAF) V600E mutation associated with a metastatic brain tumor caused by the amelanotic melanoma. A 60-year-old man was transferred to our department following acute onsets of left upper limb paralysis and convulsion. In the brain imaging, multiple lesions in the right frontal lobe and left basal ganglia were detected, and the presence of an enlarged left axillary lymph node was revealed. Consequently, we removed the right frontal lesion and performed a biopsy of the left axillary lymph node. Histological analysis of both specimens indicated an amelanotic melanoma, and genetic testing revealed a BRAF V600E mutation. The residual intracranial lesions were treated with stereotactic radiotherapy and molecular-targeted therapy, with dabrafenib and trametinib as the systemic treatment. Based on the Response Evaluation Criteria in Solid Tumors, we determined that the patient achieved complete remission (CR) under uninterrupted molecular-targeted therapy over a period of 10 months. After the temporary withdrawal of dabrafenib and trametinib to avoid hepatic dysfunction, a new intracranial lesion appeared. CR of this lesion was achieved following reinstatement of the two drugs. These results suggest that, under limited conditions, molecular-targeted therapy can produce a sustained response against the intracranial metastasis of melanoma, and the therapy with reduced dose is still effective against a recurrent case after cessation of the therapy due to the toxicity. The Japan Neurosurgical Society 2023-03-24 /pmc/articles/PMC10101700/ /pubmed/37065875 http://dx.doi.org/10.2176/jns-nmc.2022-0227 Text en © 2023 The Japan Neurosurgical Society https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License. |
spellingShingle | Case Report FUJITA, Juntaro TOMITA, Yusuke ICHIMURA, Koichi YAMASAKI, Rie NISHIGAKI, Shohei NITTA, Yuki INOUE, Yusuke SOTOME, Yuta KIDANI, Naoya MURAOKA, Kenichiro HIROTSUNE, Nobuyuki NISHINO, Shigeki A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title | A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title_full | A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title_fullStr | A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title_full_unstemmed | A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title_short | A Unique Case of Intracranial Amelanotic Melanoma with BRAF V600E Mutation Successfully Treated via Molecular-targeted Therapy |
title_sort | unique case of intracranial amelanotic melanoma with braf v600e mutation successfully treated via molecular-targeted therapy |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101700/ https://www.ncbi.nlm.nih.gov/pubmed/37065875 http://dx.doi.org/10.2176/jns-nmc.2022-0227 |
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