Combination therapy of imiquimod and gentian violet for cutaneous melanoma metastases

Abstract

To the Editor: The patient was a 92-year-old white man with significant history of anemia of chronic disease with probable hemolysis from metallic aortic valve, requiring anticoagulation with warfarin. He also had gastric antral vascular ectasia and chronic kidney disease, leading to continuous bleeding. He received periodic blood transfusions as well as epoetin alpha and darbepoetin alpha. Seven years before treatment, he was noted to have marginal zone lymphoma, stage IVA (CD20+). Ten months before treatment, he was noted to have an exophytic growth on his scalp. Biopsy specimen revealed melanoma, with a Breslow thickness of at least 6.1 mm, 20 mitosis per high-powered field, extensive ulceration, and angiolymphatic invasion. The lesion was negative for microsatellites. Thus, the tumor, using American Joint Committee on Cancer staging, was pT4bN0. Staging workup at this time using positron emission/computerized tomography revealed bilateral cervical adenopathy and pulmonary nodules less than 1 cm in diameter. The lesion was excised, but rapidly recurred. The patient received radiation therapy to his scalp lesion, followed by regression of the scalp lesion.