title: Inoperable bulky melanoma responds to neoadjuvant therapy with vemurafenib.
abstract: A patient with a bulky inoperable stage IIIC melanoma involving the left axilla and neck from a primary of the left medial elbow received vemurafenib as neo-adjuvant treatment. Based on the molecular analysis, BRAF V600E mutation was present. After 4 months of vemurafinib treatment, the tumours shrank to less than 50% of original clinical size and allowed the surgeons to perform a left modified radical neck dissection and left radical axillary dissection. Pathological analysis of specimen revealed viable metastatic cells only in 1 of 40 nodes resected in the neck and axillary dissection, accounting for over 98% pathological response. Other lymph nodes had a mixture of foamy histiocytic inflammatory reaction fibrosis and islands of necrotic tissues. After recovery from surgery, vemurafenib was resumed and continued for 6 months. He remained disease free 6 months after surgery.
authors.affiliation: Department of Surgery, The Center for Melanoma Research and Treatment in California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Niloofar
authors.initials: N
authors.lastname: Fadaki
authors.forename: Servando
authors.initials: S
authors.lastname: Cardona-Huerta
authors.forename: Lea
authors.initials: L
authors.lastname: Martineau
authors.forename: Suresh
authors.initials: S
authors.lastname: Thummala
authors.forename: Shih-Tsung
authors.initials: ST
authors.lastname: Cheng
authors.forename: Steve R
authors.initials: SR
authors.lastname: Bunker
authors.forename: Richard
authors.initials: R
authors.lastname: Garcia-Kennedy
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: David
authors.initials: D
authors.lastname: Minor
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla / Q000473:pathology / Q000601:surgery; D004550:Elbow / Q000473:pathology; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009154:Mutation; D009333:Neck / Q000473:pathology / Q000601:surgery; D020360:Neoadjuvant Therapy; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D013449:Sulfonamides / Q000627:therapeutic use*; D000077484:Vemurafenib
chemical_list: D000970:Antineoplastic Agents; D004791:Enzyme Inhibitors; D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf