2011 Volume 121 Issue 8 Pages 1595-1599
A 79-year-old man had had a black macule on his left heel for several years. The macule enlarged and formed a tumor, so he came to our hospital in October of 2005. Physical examination showed an eroded tumor with irregularly-shaped, black to brown macule on his left heel. A clinical diagnosis of malignant melanoma was made, and wide local excision and inguinal lymph node dissection were done. The post-operative pathological tumor stage was pT4bN1aM0. After surgery, he was followed up with local injection of interferon-β. Seven months after the operation, multiple in-transit metastases, multiple lung metastases, and one focus of liver metastasis were detected, so chemotherapy with DTIC/ACNU/VCR was started. Because this regimen produced no beneficial response, the therapy menu was changed to chemoimmunotherapy using monochemotherapy with dacarbazine and topical application of a potent contact sensitizer, SADBE. After successful SADBE sensitization, weekly or biweekly topical SADBE immunotherapy was started from a concentration of 0.01%. Local inflammation was minimal, and the application concentration was raised gradually up to 2%. Edematous erythema was observed only after application of 2% SADBE with an occulusive dressing technique; after that, the in-transit metastases became smaller and finally flat.
