Altered Morphology and Immunohistochemical Characteristics in Metastatic Malignant Melanoma After Therapy With Vemurafenib

Am J Dermatopathol. 2016 Sep;38(9):e137-9. doi: 10.1097/DAD.0000000000000619.

Abstract

Metastatic melanoma is traditionally diagnosed using classic morphologic features in addition to immunohistochemical studies. The authors report a case of metastatic malignant melanoma where both morphology and immunohistochemistry were altered after treatment. This 51-year-old patient presented with metastatic melanoma to the brain and axilla. Initially, both metastases showed classic morphology and diffuse staining with the pan-melanoma antibody cocktail. This cocktail is a combination of 3 antibodies commonly used to diagnose melanocytic neoplasms: Melan-A (MART-1), tyrosinase, and HMB-45. In combination, the cocktail is highly sensitive for detecting melanocytic neoplasms and is commonly used to diagnose metastatic melanoma. Her tumor was positive for the BRAF 1799T>A (V600E) mutation, and she was treated with BRAF inhibitor therapy (vemurafenib). However, the axillary tumor recurred after treatment with vemurafenib. The recurrent tumor showed a markedly different morphology and complete loss of staining with the pan-melanoma antibody cocktail. This loss of staining accompanied by the change in morphology was an observation not previously documented after therapy with vemurafenib. This case demonstrates a potential pitfall in the diagnosis of metastatic or recurrent malignant melanoma.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Biomarkers, Tumor / analysis
  • Brain Neoplasms / drug therapy
  • Brain Neoplasms / secondary
  • Female
  • Humans
  • Immunohistochemistry
  • Indoles / therapeutic use*
  • Lymphatic Metastasis / pathology
  • Melanoma / drug therapy*
  • Melanoma / secondary*
  • Melanoma, Cutaneous Malignant
  • Middle Aged
  • Skin Neoplasms
  • Sulfonamides / therapeutic use*
  • Vemurafenib

Substances

  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Indoles
  • Sulfonamides
  • Vemurafenib