Disease Regression in Malignant Melanoma: Spontaneous Resolution or a Result of Treatment With Antioxidants, Green Tea, and Pineapple Cores? A Case Report

Abstract

Malignant melanoma is a rare cancer with an incidence of 3% in the United Kingdom. It has been previously reported to undergo spontaneous remission. The incidence of metastatic melanoma with a completely regressed or unknown primary cutaneous lesion is estimated at 3% to 15%; regression of metastases is very rare. We describe a case of a 47-year-old woman who was diagnosed with stage III malignant melanoma in March 2004. The initial lesion measured 2.5 cm in diameter, was pigmented, and was situated in the left posterior angle of the neck. The excision biopsy confirmed malignant melanoma Breslow thickness 1.75 mm, Clark level IV with vertical and lateral spread, pT2a. Following excision biopsy, the patient had a wide local excision and sentinel lymph node biopsy. The wide local excision showed no residual melanoma cells, but there were melanoma cells in 1 of the 2 sentinel lymph nodes found. She therefore proceeded to left radical neck dissection and nodal clearance. None of the 26 lymph nodes excised showed melanoma cells. The staging computed tomography (CT) scan at the time did not show any evidence of distant metastases, and the final American Joint Committee on Cancer staging was IIIA. Sixteen months later, she gave a history of nausea for several weeks and weight loss of 7 lb. Although the symptoms were settling, a CT scan was arranged, which showed metastatic disease in the lungs and liver. Initially, no treatment was instigated, and the plan was to repeat CT in 2 months. The patient, who was obviously very upset at the diagnosis, decided to change her diet by adding antioxidants in the form of Nutriedge supplement (Genesis Enterprise); green tea, 2 to 3 cups per day on the advice of her brother, who is a physician in Australia; and pineapples, 2 per week, including the minced fruit cores. Nutriedge formula contains a combination of antioxidants available over the counter, mainly αand β-carotene, vitamin C, selenium, and vitamin E. The patient maintained an active lifestyle with regular exercise as well as the nutritional supplements mentioned above. The CT scan, repeated as planned, showed almost complete resolution of lung and liver metastases (see Figures 1 and 2). Spontaneous regression of cancer is rare, and the evidence is often anecdotal. The stories of cancer resolution as a result of lifestyle change or alternative therapy are even more infrequent and should be regarded with caution. Melanoma, on the other hand, is one of the rare tumors for which spontaneous regression is not unheard of. King et al reviewed the literature and described one such case in 2001. The literature suggests that the regression is more likely to occur if there is some nonspecific event such as local infection, autoimmune illness, transfusion reaction, a biopsy, or incomplete excision. Such behavior would suggest a correlation with an immune system response, although the mechanism itself is poorly understood. It is likely to be T-lymphocyte driven following recognition of a tumor antigen presented de novo to the immune system. In the case of our patient, there is no specific event other than a lifestyle change and a healthy diet as well as an increased intake of the antioxidants, green tea, and pineapples, including the fruit cores. The evidence for use of antioxidants in cancer is extensive; however, the data remain confusing. Green tea, for example, acts via the active compounds, mainly catechins, and causes inhibition of vascular endothelial growth factor–induced angiogenesis. A large Japanese study from 1986 showed a delayed cancer onset in