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Brief Report
January 9, 2019

Evaluation of the Response of Unresectable Primary Cutaneous Melanoma to Immunotherapy Visualized With Reflectance Confocal Microscopy: A Report of 2 Cases

Author Affiliations
  • 1Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
  • 3Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 4Weill Cornell Medical College, New York, New York
  • 5Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Dermatol. 2019;155(3):347-352. doi:10.1001/jamadermatol.2018.3688
Key Points

Question  Is it possible to monitor locally advanced primary melanomas and cutaneous metastasis treated with systemic immunotherapy using reflectance confocal microscopy?

Findings  In this case report study of 2 patients with locally advanced primary melanomas, reflectance confocal microscopy was found to correlate well with the clinical and histopathologic findings, thus showing a possible role in the treatment monitoring of these patients.

Meaning  Reflectance confocal microscopy is potentially a novel, noninvasive tool for imaging and monitoring of cutaneous involvement of advanced melanomas treated systemically.


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.