November/December 2015
Volume 13 • Issue 6
correspondence Snejina Vassileva, MD, PhD, Section Editor
Curative Electrochemotherapy in Lentigo Maligna Melanoma Alessandro Gatti, MD;¹ Giuseppe Stinco, MD;² Nicola di Meo, MD;¹ Serena Bergamo, MD;² Giusto Trevisan, MD¹ To the Editor: The term electrochemotherapy (ECT) describes a local treatment in which electroporation is used in order to potentiate the cytotoxicity of a usually poorly permeating chemotherapeutic drug, such as bleomicin or cisplatin, by increasing tumor cell permeability with the application of electric pulses.1 In clinical practice, ECT is used mainly as a palliative treatment for melanoma, including cutaneous metastasis. It is also used to treat head and neck tumors, as well as primary basal cell carcinoma, Kaposi sarcoma, breast tumors, and metastatic cancers including hypernephroma and chondrosarcoma.2,3 Clinical Findings We present the case of an 84-year-old woman who came to our outpatient clinic for the appearance of a bleeding nodule on her right cheek, arising on a preexisting brown-black pigmented macule present for almost 3 years, which she reported to be in slow but constant growth (Figure 1a). The whole lesion was approximately 5×3 cm in its major axes, and it occupied a huge portion of her right cheek. The appearance of the nodular, easily bleeding mass triggered her to consult us. The clinical impression was a lentigo maligna melanoma with satellite metastases. Both the patient and her relatives declined any form of surgical therapy, and they also refused even a small incisional biopsy in order to obtain a histologic diagnosis for staging. As a result, we proposed ECT as an alternative to traditional surgery, and the patient accepted this option. She also had diabetes mellitus, hypertension, and vascular encephalopathy. The patient was eli-
gible for ECT because she did not have pulmonary fibrosis, coagulation disorders, an allergic reaction to bleomycin, epilepsy, peripheral neuropathy, chronic renal failure, or an arrhythmia, nor did she have a pacemaker. Treatment We decided to treat both the primary lesion and the satellite metastasis simultaneously with ECT, with 1 cm of perilesional clinically healthy skin, using a bolus of bleomycin and a pulse generator under general anesthesia. Bleomycin was injected intravenously at a dose of 22,500 UI (15 mg/m2 body surface area) 8 minutes before electric pulses delivery, with a hexagonal array of electrodes of 20 mm (Cliniporator, type III electrodes) (as specified by the manufacturer, IGEA, Carpi, Italy). The duration of the treatment was less than 20 minutes. The patient was monitored for 1 day after the treatment in our inpatient clinic, with intravenous paracetamol 1 g every 6 hours as postsurgical analgesia. Side effects included only local edema with a transudate, occurring within a few days after the ECT session. At 6 months, there remained a scar and three areas of blue regressive pigmentation (Figure b). At 12 and 18 months, the pigmented portion was reduced to two salt and pepper pattern areas (Figure c and d). No metastatic disease was seen on positron emission tomography/computed tomographic scan at 24-month follow-up. In treating melanoma, wide surgical excision remains the therapy of choice. Recently, ECT has been proposed as a new treatment modality for widespread cutaneous and subcutaneous metastases
From the Dermatology Department, University of Trieste, Italy;¹ and the Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy2 Address for Correspondence: Nicola di Meo, MD, University of Trieste, Dermatology Department,Ospedale Maggiore di Trieste, Clinica Dermatologica, Universita’ Degli Studi di Trieste, IV piano Palazzina Infettivi, Piazza Ospedale 1, 34100, Trieste, Italia • E-mail: nickdimeo@libero.it
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