title: [Breast lesions of a metastatic melanoma on a radiotherapy territory: Treatment by vemurafenib and carcinologic surgery].
abstract: BACKGROUND
  This article describes the unique case of a female patient who presented distant melanoma metastasis on the breast while having irradiation therapy for breast cancer. This happened eight months after the initial treatment for a melanoma of the back (under the right scapula). Furthermore, this case report demonstrates the efficiency of Vemurafenib® as a treatment for late stage melanomas.
  
  
  METHODS
  The patient was a 47-year-old female that had a superficial spreading melanoma under the right scapula (Breslow 1.02mm) that was treated with 2cm skin excision and sentinel lymph node sampling that was negative. The melanoma was positive for the BRAF600E mutation. One month after this incident, the patient developed breast cancer that was treated with conservative surgery and radiotherapy. Three months after the end of the irradiation treatment, she developed multiple melanoma metastasis on the skin of the breast. Our multidisciplinary team decided to initiate a treatment with vemurafenib. The patient showed an excellent response, so the surgical team completed the treatment with a radical mastectomy and immediate reconstruction with a pedicled latissimus dorsi flap. The histologic report of the mastectomy specimen showed no sign of melanocytic proliferation, that demonstrates the efficacy of vemurafenib. The patient showed no relapse after two years of follow-up.
  
  
  CONCLUSIONS
  The speed of development and location of cutaneous metastases in this case brought us to think about the effects of radiation therapy on the skin. Radiation therapy causes acute complications (radiodermatitis) by cellular and molecular mechanisms. Moreover, depressed immunity is found after irradiation. Association of these mecanisms could explain the appearance of these metastases in irradiation field. The efficiency of vemurafenib found in our case is consistent with what is described in literature, especially with the improvement in median overall survival.
  
  
  CONCLUSIONS
  This case demonstrates a unique case of distant melanoma metastasis on the irradiation field of a breast cancer. It also demonstrates the efficacy of vemurafenib as well as the efficacy of a radical complementary surgical treatment in these patients.
authors.affiliation: Service de chirurgie plastique, réparatrice et esthétique, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France. Electronic address: fernandez.jonathan11@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Service de dermatologie, hôpital de l'Archet 2, CHU de Nice, 151, route de Saint-Antoine, 06200 Nice, France.
authors.forename: H
authors.initials: H
authors.lastname: Montaudié
authors.affiliation: Pôle de radiothérapie, centre Antoine-Lacassagne, 31, avenue de Valombrose, 06103 Nice, France.
authors.forename: A
authors.initials: A
authors.lastname: Courdi
authors.affiliation: Service de chirurgie plastique, réparatrice et esthétique, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
authors.forename: C
authors.initials: C
authors.lastname: Georgiou
authors.affiliation: Service de chirurgie plastique, réparatrice et esthétique, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
authors.forename: O
authors.initials: O
authors.lastname: Camuzard
authors.affiliation: Service de chirurgie plastique, réparatrice et esthétique, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
authors.forename: B
authors.initials: B
authors.lastname: Chignon-Sicard
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D016462:Mammaplasty; D008408:Mastectomy; D008545:Melanoma / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000628:therapy*; D012540:Scapula / Q000601:surgery; D012878:Skin Neoplasms / Q000556:secondary* / Q000628:therapy*; D013449:Sulfonamides / Q000627:therapeutic use*; D000077484:Vemurafenib
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib
keywords: BRAFV600E; Breast cancer; Cancer du sein; Champ d’irradiation; Cutaneous metastasis; Immunomodulation; Irradiation territory; Melanoma; Mélanome; Métastases cutanées; Radiotherapie; Radiothérapie; Survie; Survival; Vemurafenib; Vémurafénib