Tumoral Melanosis and Separate Granulomatous Inflammation due to Talimogene Laherparepvec

A 78-year-old man received immunotherapy for in-transit metastatic melanoma papulonodules on his left lower abdomen in the form of intralesional injections of talimogene laherparepvec (T-VEC), an oncolytic genetically modified herpes virus. Despite therapy, the colour and size of the lesions remained clinically unchanged; however, histopathological examination revealed only melanophages in the absence of melanoma cells. The diagnosis of tumoral melanosis secondary to immunotherapy with T-VEC was made. This case emphasizes the importance of histopathological evaluation in assessing response to immunotherapy of in-transit metastatic melanoma lesions.

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Papulonodular pigmented lesions in a patient with Stage IV malignant melanoma

Daruish

Papa

Geh

et al. 2022

Clinical and Experimental Dermatology

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Tumoral melanosis mimicking residual melanoma in the setting of talimogene laherparepvec treatment

Park

Green

Hadi

et al. 2022

J Immunother Cancer

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Talimogene laherparepvec (T-VEC) has become an increasingly popular treatment option for surgically non-resectable, recurrent melanoma, usually of cutaneous metastases. The complete response (CR) rate has been reported to be ~20% with a median of ~9 months to achieve it. In real-world practice, decrease of tumor size often occurs rapidly within the first 2–3 months, while improvement of the pigmentation takes several more months. Such clinical observation of lasting pigmentation could be explained by tumorous melanosis—a histopathological term referring to the presence of a melanophage-rich inflammatory infiltrate without remaining viable tumor cells. Herein, we report six patients with metastatic cutaneous melanoma who were treated with T-VEC. Biopsies were performed after observing clinical responses in the injected tumors. Pathological evaluation demonstrated non-viable or absent tumor tissue with tumorous melanosis in all cases. To accurately assess response to therapy and potentially decrease unnecessary additional T-VEC treatments, serial biopsy of ‘stable’ lesions should be considered to assess the presence or absence of viable tumor.

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Tumoral Melanosis and Separate Granulomatous Inflammation due to Talimogene Laherparepvec

Abstract: Human keratinocytes are a source for tumor necrosis factor alpha: evidence for synthesis and release upon stimulation with endotoxin or ultraviolet light.

Cited by 2 publications

References 7 publications

Papulonodular pigmented lesions in a patient with Stage IV malignant melanoma

Papulonodular pigmented lesions in a patient with Stage IV malignant melanoma

Tumoral melanosis mimicking residual melanoma in the setting of talimogene laherparepvec treatment

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