610 A case of metastatic malignant melanoma of the scalp responding to ipilimumab
Bibliographic record
Abstract
We report a case of advanced stage metastatic malignant melanoma of the scalp with a durable (31 month) progression-free response to ipilimumab immunotherapy. The case is presented along with a brief review of the literature that discusses choice of systemic therapy for advanced cutaneous melanoma and BRAF mutant melanoma. A 60-year-old-female presented with advanced stage lentigo maligna melanoma of the scalp. She was managed surgically with excision of the majority (80%) of the scalp and split thickness skin graft reconstruction. Post-operatively her disease progressed with development of extensive in-transit metastasis (involving the new graft) and and local lymph node invasion. This patient’s tumor had a BRAF V600E mutation and was treated systemically first with dabrafenib but there was disease progression after three months of therapy and she subsequently underwent four rounds of immunotherapy with ipilimumab. She tolerated therapy and responded remarkably with complete resolution of lymphadenopathy and thinning of pigmented lesions. Response has been maintained to date, with no new sites of metastasis or symptoms at most recent 31-month follow-up. This is the first case study reporting long-term, progression-free response to ipilimumab in metastatic melanoma without side effects of therapy. There is increasing evidence supporting the long-term survival benefit of ipilimumab even in cases of aggressive metastatic melanoma. Unique to immunotherapy, there is potential to produce a durable treatment-free remission in selected patients with advanced melanoma. This case adds to the evidence for starting ipilimumab early in patients that can tolerate it with the goal of producing a sustained treatment-free response and preserved quality of life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".