Cristian Navarrete-Dechent1,2, Miguel Cordova1, Michael A Postow3,4, Melissa Pulitzer5, Cecilia Lezcano5, Allan C Halpern1, Anthony M Rossi1,4. 1. Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. 3. Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Weill Cornell Medical College, New York, New York. 5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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.
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.
Authors: Cristian Navarrete-Dechent; Konstantinos Liopyris; Jilliana Monnier; Saud Aleissa; Lindsay M Boyce; Caterina Longo; Margaret Oliviero; Harold Rabinovitz; Ashfaq A Marghoob; Allan C Halpern; Giovanni Pellacani; Alon Scope; Manu Jain Journal: J Am Acad Dermatol Date: 2020-05-23 Impact factor: 11.527