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May 2011

NRAS-Mutant Melanoma: Response to Chemotherapy

Author Affiliations

Author Affiliations: Department of Dermatology (Dr Soon), Division of Hematology and Oncology, Department of Medicine (Drs Algazi, Cha, and Daud), and Department of Radiology (Dr Webb), University of California, San Francisco.

Arch Dermatol. 2011;147(5):626-627. doi:10.1001/archdermatol.2011.85

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.

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