An 84-year-old man presented to our clinic with a primary, 2.3-mm-thick, nonulcerated melanoma of the right earlobe, which was found to have an NRAS exon 2 Q61L mutation. After removal of the melanoma, he remained disease free until 2 years later, when a positron-emission tomography/computed tomography (PET/CT) scan revealed lung and liver metastases, confirmed by biopsy. He began chemotherapy with oral temozolomide at a dose of 75 mg/m2/d (21-day cycle, 14 days on treatment and 7 days off). After 4 cycles, a PET/CT scan showed a decrease in the size of his pulmonary nodules, resolution of his liver lesion, and an absence of hypermetabolism. Subsequent PET/CT scans demonstrated stable pulmonary nodules, consistent with scarring. We stopped temozolomide treatment after 7 months owing to patient weakness and fatigue. At last follow-up, he had no evidence of disease and was asymptomatic 14 months after initiating temozolomide therapy.
Soon CWM, Algazi AP, Cha EN, Webb EM, Daud AI. NRAS-Mutant Melanoma: Response to Chemotherapy. Arch Dermatol. 2011;147(5):626-627. doi:10.1001/archdermatol.2011.85