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JAMA Oncology Clinical Challenge
November 2015

Melanoma and a Headache

Author Affiliations
  • 1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Oncol. 2015;1(8):1167-1168. doi:10.1001/jamaoncol.2015.2537

A 60-year-old man with advanced melanoma presented with headaches and increasing fatigue during treatment with ipilimumab. Several months earlier, he presented to the emergency department with shortness of breath. Imaging revealed pulmonary emboli and incidental groin lymphadenopathy. Biopsy of a lymph node showed melanoma. He then underwent inguinal lymph node dissection and was found to have 9 lymph nodes involved with melanoma (stage IIIC melanoma).

He was then treated with ipilimumab (3 mg/kg), a monoclonal antibody to cytotoxic T lymphocyte antigen-4 (CTLA-4), every 3 weeks, as part of an investigational adjuvant therapy clinical trial. When presenting for his fourth and final dose of ipilimumab, he reported central headaches, severe fatigue, poor appetite, intermittent nausea, and a mild rash. On examination, vital signs were within normal limits. Physical examination had largely unremarkable results except for a slightly red, raised rash over his chest and proximal extremities.

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