2016 Volume 126 Issue 4 Pages 419-424
A 73-year-old woman underwent surgery for a black macule on the right forearm when she was 70-year-old. Histopathological analysis revealed malignant melanoma. She underwent extended resection and biopsy of the sentinel lymph node. The sentinel lymph node was negative for melanoma (tumor thickness 1.4 mm, pT2aN0M0, Stage IB). After the surgery, local injection of interferon-β followed 3 months. When she was 73-year-old, chest X-ray revealed multiple nodular shadows on her both lungs. She had undergone partial resection of lung. Histopathological analysis was consistent with lung metastasis of malignant melanoma. She underwent 8 courses of chemotherapy of dacarbazine. However, she had new metastases in brain, liver, and bone. Thereafter, she received treatment of nivolumab (2 mg/kg was administered every 3 weeks). After the third nivolumab, lung and liver metastases decreased the size by over 30%. After the fifth nivolumab, brain metastasis decreased the size by 38%. After the sixth nivolumab, she had severe interstitial pneumonias due to nivolumab, leading to discontinuation of nivolumab. However, lung and liver metastases decreased the size even more 12 weeks after discontinuation and brain metastasis also decreased 16 weeks after discontinuation. Positron emission tomography (PET) revealed improvement of bone metastasis. Thus, nivolumab was effective to every metastasis lesion including brain, lung, liver, and bone in this patient. While there is no clear evidence of effectiveness of nivolumab on brain metastasis, nivolumab could be a useful choice for patients with multiple metastases including brain lesion.