Thalidomide for Malignant Melanoma

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Abstract
A 63-year-old man with a dense left hemiplegia from a stroke two and a half years earlier was seen in the clinic in May 2000 with clinical evidence of relapsed malignant melanoma of the scalp. Stage II malignant melanoma over the vertex had first been diagnosed in March 1999. In July 1999, the lesion was widely excised, with a 1-cm margin of normal tissue. The diameter of the melanoma was 1 cm and its depth 4 mm. The margin was tumor-free. He received no adjuvant therapy. In March 2000, two lesions developed, one measuring 10 by 8 mm over the right parietal region and the other measuring 4 by 4 mm over the scalp and forehead in the midline; each was accompanied by three satellite nodules measuring 2 by 2 mm. He was not considered to be a candidate for aggressive therapy and was referred to us for a second opinion in May 2000. A fine-needle aspiration biopsy confirmed the presence of recurrent malignant melanoma ( Figure 1 ), with the cells staining positive for the antigens S-100 and HMB-45. The lesions were judged to be in-transit metastases, since they were both more than 2 cm away from the site of the primary lesion. Imaging studies confirmed that the disease was localized to the scalp.

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