Scalp Melanoma Research Articles

Rapidly progressing scalp melanoma in an elderly patient.

A rapidly progressing scalp melanoma incorrectly diagnosed and managed as a 'chronic wound', lead to delayed referral to dermatologist and correct diagnosis. This case highlights the importance of early diagnosis of scalp melanoma and of frailty screening in elderly patients.

Pembrolizumab-Induced Pancytopenia: A Case Report

Introduction: Immunotherapy is increasingly acknowledged as an effective treatment for metastatic melanoma. Hematological immune-mediated adverse events are rarely reported. In this article, we report a case of a patient who developed pancytopenia following administration of pembrolizumab. Case Report: A 63 -year-old woman, followed for a scalp melanoma with pulmonary metastasis developed severe pancytopenia after receiving 4 cycles of pembrolizumab. Outcome and Management: Following the appearance of the adverse effect, Pembrolizumab was stopped. A series of blood tests were performed in order to get the reasons of this event. The patient received high-dose of corticosteroids with tapering the dose over 6 weeks, and blood transfusion was required. Discussion: Checkpoint inhibitors (ICI) stimulate both humoral and cellular immune responses against tumor antigens, potentially resulting in immune-related adverse effects, including hematological issues like pancytopenia. Due to the substantial morbidity and mortality linked to ICI-induced pancytopenia, further data is essential to formulate evidence-based management guidelines.

A Cautionary Note on Pembrolizumab use in Patients with Ascending Aortic Aneurysms.

We describe a case of a patient treated with pembrolizumab (an immune checkpoint inhibitor) for metastatic scalp melanoma. He had a previous history of colorectal cancer, prostatic cancer and chronic polymyalgia rheumatica. The patient was known to have a stable ascending aortic aneurysm of 4.5 cm. However, he developed a rapid expansion of the ascending aortic aneurysm with the size crossing the threshold for surgery. The patient was referred to the cardiothoracic surgery service for intervention and he subsequently underwent surgery. The patient was electively admitted one week later for resection of aortic aneurysm, aortoplasty and external graft fixation. Pathologically, gross evidence of dissection was not identified; however, the histological analysis of the media showed laminar medial necrosis, multifocal in nature, with occasional clusters of histiocytic cells appreciated at their edge reminiscent of that seen in an inflammatory aortitis (granulomatous/giant cell type). Immune checkpoint inhibitor-induced aortitis is becoming increasingly evident, and its presentation can vary. It has been discovered incidentally on surveillance imaging with the use of nivolumab. In other cases, patients have been symptomatic to severely symptomatic. Atezolizumab with carboplatin and etoposide has been reported to cause abdominal aortitis which was responsive to corticosteroids and subsequent discontinuation of atezolizumab. Pembrolizumab has been linked to a case of transverse aortic arch aortitis. In our case, the inflammatory aortitis due to pembrolizumab was the cause of the rapid expansion of the ascending aortic aneurysm. Patients with known aortic aneurysms should undergo careful surveillance when commencing immune-checkpoint inhibitor therapy. Immune checkpoint inhibitors are being increasingly used in the treatment of metastatic malignancy. However, they are a relatively new group of medications, and the side effect profile of each is yet to be fully recognised. Aortitis has occurred with several different immune checkpoint inhibitors.Patients with known aortic aneurysms should undergo careful surveillance when commencing immune checkpoint inhibitors.All interventional therapeutic options should be considered early in these patients on the development of aneurysmal expansion.

Scalp Melanoma: A High-Risk Subset of Cutaneous Head and Neck Melanomas with Distinctive Clinicopathological Features.

Scalp melanomas (SM) have been previously associated with poor overall and melanoma-specific survival rates. The aim of this study was to describe and compare the clinicopathological characteristics and survival outcomes of SM and non-scalp cutaneous head and neck melanoma (CHNM). An observational multi-center retrospective study was designed based on patients with CHNM followed in two tertiary care hospitals. A hundred and fifty-two patients had CHNM, of which 35 (23%) had SM. In comparison with non-scalp CHNM, SM were more frequently superficial spreading and nodular subtypes, had a thicker Breslow index median (2.1 mm vs. 0.85 mm), and a higher tumor mitotic rate (3 vs. 1 mitosis/mm2) (p < 0.05). SM had a higher risk of recurrence and a higher risk of melanoma-specific death (p < 0.05). In the multivariate analysis, scalp location was the only prognostic factor for recurrence, and tumor mitotic rate was the only prognostic factor for melanoma-specific survival. We encourage routinely examining the scalp in all patients, especially those with chronic sun damage.

Survival outcomes of head and neck melanoma patients in Queensland, Australia from 2009 to 2018.

To compare survival outcomes for patients with cutaneous invasive head and neck melanoma (HNM) with those of patients with melanoma on other anatomical sites. Retrospective cohort study using patient data extracted from the Cancer Alliance Queensland's Oncology Analysis System (OASYS) over a 10-year period from 2009 to 2018. Melanoma-specific survival was compared between patients with HNM and non-HNM. Kaplan-Meier survival estimates were calculated at 5 and 10 years. Univariable and multivariable Cox proportional hazards regression analysis determined factors associated with survival. The 5- and 10-year survival probabilities were 90.7% and 89.1%, respectively for HNM, compared with 94.7% and 93.0%, respectively, for non-HNM melanoma. The 5- and 10-year survival probabilities for scalp melanoma were 77.8% and 75.5%, respectively. Patients with HNM died of melanoma at 1.22 times (HR 1.22, 95% CI 1.09-1.37) the rate of those with non-HNM, controlling for sex, age, socioeconomic status, remoteness, Breslow thickness, the presence of multiple invasion melanoma and ulceration. Patients with scalp melanoma died of melanoma at 1.57 times (HR 1.57, 95% CI 1.26-1.95) the rate of those with non-scalp HNM. There is a statistically significant survival difference between patients with HNM and non-HNM, and between patients with scalp melanoma and non-scalp HNM, even after adjusting for prognostic factors.

Sentinel Lymph Node Biopsy in Malignant Melanoma of the Head and Neck: A Single Center Experience.

This study evaluated the characteristics of patients with head and neck (H&N) melanoma who underwent sentinel lymph node biopsy (SNLB) and assessed the clinical course of patients categorizing subjects according to SLNB status and melanoma location (scalp area vs. non-scalp areas). Patients undergoing SLNB for melanoma of H&N from 2015 to 2021 were prospectively characterized according to sentinel lymph node (SLN) status. SPECT/CT had been previously performed. Patients were followed until the first adverse event to evaluate progression-free survival. 93 patients were enrolled. SLNB was negative in 75 patients. The median Breslow index was higher for patients with positive SLNB compared with patients with negative SLNB. In addition, the Breslow index was higher for melanoma of the scalp compared with non-scalp melanoma. The median follow-up was 24.8 months. Progression occurred at the systemic level in the 62.5% of cases. There was a significant association between positive SLNB and progression (p-value &lt; 0.01) of disease, with lower progression-free survival for patients with melanoma of the scalp compared with those with melanoma at other anatomic sites (p-value: 0.15). Scalp melanomas are more aggressive than other types of H&N melanomas. Sentinel lymph node status is the strongest prognostic criterion for recurrence.

A cross-sectional study of clinical, dermoscopic, histopathological, and molecular patterns of scalp melanoma in patients with or without androgenetic alopecia

Scalp melanoma (SM) has a worse prognosis than melanoma in other locations likely because of late diagnosis due to hair coverage, difficulties in interpreting dermoscopy findings, and its unique molecular profile. We aimed to describe the clinical, histopathological, molecular, and dermoscopic patterns of SM and its relation to androgenetic alopecia/elastosis at the tumor site. Through a retrospective cross-sectional study, we identified all SM diagnosed at the A.C.Camargo Cancer Center between 2008 and 2018. In all, 48 SM were analyzed: 45.8% of which exhibited moderate/severe androgenetic alopecia and 54.1% exhibited elastosis. Androgenetic alopecia/elastosis at the site of the SM was associated with older age (p < 0.001), chronic sun damage (p < 0.001), lentigo maligna subtype (p = 0.029), and photodamaged dermoscopic pattern (p < 0.001). Additionally, 41 cases were evaluated with a 14-gene panel: 53.7% displayed mutations and 46.3% were wild-type. BRAF mutations were most common (77%), with BRAF V600K being more frequent (50%) than BRAF V600E (31.2%). The NF1 gene was evaluated in 40 samples, of which 20% exhibited mutations. SM presents differently in areas covered by hair compared to in areas with androgenetic alopecia. Patients without alopecia may have higher Breslow thickness due to late diagnosis because of hair concealment. The high frequency of detrimental mutations can also explain the poor prognosis of SM.

Lack of association between anatomical sites of scalp melanomas and brain metastases does not support direct vascular spread.

Primary scalp melanomas are associated with a higher rate of brain metastasis than primary cutaneous melanomas occurring at other head and neck and body sites, but the reason is unclear. Spread to brain parenchyma via emissary veins draining from the scalp to dural sinuses has been suggested. We sought to examine the locations of metastases from primary scalp and nonscalp head and neck melanomas to determine whether there was anatomical evidence supporting direct venous spread to the brain. Data from patients who developed distant metastases from cutaneous head and neck melanomas (CHNMs) between 2000 and 2018 were analyzed. Anatomical sites of primary scalp melanomas and their respective intracranial metastases were compared. Times to first brain and nonbrain metastases were investigated for scalp and nonscalp primary CHNMs. Of 693 patients with CHNMs, 244 developed brain metastases: 109 (44.7%) had scalp primaries and 135 (55.3%) had nonscalp primaries. There was no significant association between anatomical sites of scalp primary melanomas and brain metastases (Cramer's V = 0.21; Chi-square P = 0.63). Compared with nonscalp CHNMs, scalp melanomas had no greater propensity for the brain as the first distant metastatic site ( P = 0.52) but had a shorter time to both brain metastasis (76.3 vs. 168.5 months; P < 0.001) and nonbrain metastasis (22.6 vs. 35.8 months; P < 0.001). No evidence was found to support a direct vascular pathway for metastatic spread of scalp melanomas to the brain. The increased incidence of brain metastases from scalp melanomas is probably driven by aggressive biological mechanisms.

The peculiar dermatoscopic pattern of scalp melanoma.

Melanomas developing on anatomic sites other than the trunk and extremities have a special pathogenetic and mutational profile, morphologic characteristics and biologic behaviour. By retrospectively screening the databases of our centres, we aimed to investigate the dermatoscopic morphology of early scalp melanoma, including in situ and invasive tumours with a Breslow thickness up to 1 mm. The databases of three specialized centres for skin cancer diagnosis and management in Greece were retrospectively evaluated to retrieve dermatoscopic images of scalp melanomas. Patients' age and sex were recorded, as well as the precise location of the tumour, using 6 possible sub-locations: frontal, parietal, occipital, temporal, nuchal scalp and vertex. The dermatoscopic images were evaluated by 3 independent investigators for the presence of pre-defined criteria. The dermatoscopic criteria included in the evaluation were selected based on available literature and were categorized in 2 groups: 'classic melanoma criteria' and 'lentigo maligna (LM) criteria'. Of 38 melanomas, 37 (97.4%) displayed brown colour and 23 (60.5%) displayed additional grey or blue colour. The most frequent dermatoscopic criteria were regression (18/38, 47.4%), grey dots/globules (17/38, 44.7%), atypical network (16/38, 42.1%), obliterated follicles (16/38, 42.1%) and angulated lines (15/38, 39.5%). Of 38 melanomas, 28 (73.7%) displayed at least 1 classic melanoma criterion plus at least 1 LM criterion. Of the remaining melanomas, 8 (21.1%) displayed only classic melanoma criteria, 1 (2.6%) only LM criteria and 1 (2.6%) did not exhibit any of the evaluated criteria. This study demonstrates that early scalp melanoma combines classic with LM criteria in terms of colours and structures.

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience.

Outcomes are thought to be worse in head and neck (H&N) melanoma patients. However, definitive evidence of inferior outcomes in H&N melanoma in the modern era is lacking. We sought to ascertain whether H&N melanomas carry a worse prognosis than melanomas of other sites. All patients who underwent excision for primary melanoma by fellowship-trained surgical oncologists at a single institution from 2014 to 2020 were queried from the electronic medical record. Patients who had AJCC eighth edition stage I-III disease were included. Of 1127 patients, 28.7% had primary H&N melanoma. H&N patients were more likely to be male, older, and present with more advanced AJCC stage. Median follow-up was 20.0months (IQR 26.4). On multivariable analyses controlling for other variables, H&N melanoma was associated with worse RFS. Notably, H&N melanoma was not associated with worse MSS, DMFS, or OS on univariate or multivariable analyses. Among patients who recurred, H&N patients were significantly more likely to recur locally compared to non-H&N patients. On subgroup analysis, scalp melanoma was also associated with worse RFS compared to patients with melanoma in locations other than the scalp. When patients with scalp melanoma were excluded from analysis, non-scalp H&N RFS was not significantly different from the non-H&N group on univariate or multivariable analyses. In this series from a high-volume tertiary referral center, the differences in rates and sites of recurrence between H&N and non-H&N melanoma do not impact melanoma-specific or overall survival, suggesting that H&N melanoma patients should be treated similarly with respect to regional and systemic therapies.

Diagnosis and Management of Melanoma of the Scalp: A Review of the Literature.

Cutaneous melanoma is a public health issue and the head and neck region is of particular interest, despite accounting for only 9.0% of the total body surface, it harbours 20% of melanoma cases. Data from the literature show that scalp melanomas (SM) carry high mortality rates, with a 10-year survival rate of 60% which lead them to be named as the “invisible killer”. Moreover, SMs are more common in the elderly than in young population, and they occur six times more frequently in men than in women. This is probably related to the higher incidence of androgenetic alopecia and a higher cumulative and intermittent ultraviolet damage on the scalp. Histologically, SM is a heterogenous group, including lentiginous melanoma (LM), desmoplastic melanoma, superficial spreading and nodular melanoma. Thin melanomas tend to display an atypical network or pseudo-network and regression in dermoscopy. Blue-white veil, irregular pigmented blotches and an unspecific pattern are most commonly detected in thick lesions. On reflectance confocal microscopy (RCM), the most frequent pattern is irregular meshwork, but also ringed and disarranged pattern have been described. Differential diagnosis includes benign solar lentigo, actinic keratoses, lichen planus like keratosis, melanocytic nevi and blue nevi. All suspicious lesions should be biopsied; therefore, an excisional biopsy with 2 mm margins is usually the best option. The management of SM is the same as for melanoma on other body sites. However, sentinel node biopsy tends to be more challenging, as well as achieving adequate excision margins of the primary tumor. In this review, we summarize clinical, pathologic, dermoscopic and RCM features of SM, and focus on its epidemiology, risk factors and best management options.

Dermoscopic features of a primary scalp melanoma and its cutaneous metastases.

Dermoscopic features of a primary scalp melanoma and its cutaneous metastases.

Current treatment strategy for resectable scalp and neck melanoma

Melanoma is a malignant skin tumor associated with a poor clinical prognosis. The incidence of melanoma is constantly rising. Several studies demonstrated that overall and relapse-free survival rates in patients with head and neck melanoma were lower than those in patients with skin melanoma of other locations. Some authors showed that patients with scalp melanoma had the worst prognosis.Surgery is currently the main treatment option for resectable skin melanoma. It has a number of specific characteristics, such as the need for a smaller resection margin at primary tumor removal in some cases, lower accuracy of sentinel lymph node identification due to the complexity of lymph flow from the scalp and neck, and changes in the standard volumes of lymphadenectomy considering lymph flow from the scalp and neck. Oncologists should have reconstructive surgery skills, because their aim is not only to ensure complete tumor excision, but also to achieve a satisfactory appearance of the patient, especially if the tumor is located in the face, open areas of the head and neck and ears, since this is of functional and aesthetic importance. The administration of adjuvant therapy still causes some controversy in cases where both radiation therapy and pharmacotherapy are indicated.In this article, we describe the main characteristics of the current treatment strategy for resectable scalp and neck melanoma and cover the main problems in this area that have not been addressed so far.

Flat scalp melanoma dermoscopic and reflectance confocal microscopy features correspond to histopathologic type and lesion location.

BackgroundDermoscopy and Reflectance Confocal Microscopy (RCM) features of scalp melanoma according to lesion location and histopathology have not been fully investigated.ObjectivesTo reveal dermoscopic and RCM features of scalp melanoma according to lesion location and histopathology.MethodsWe retrospectively retrieved images of suspicious, atypical excised, flat melanocytic lesions of the scalp, assessed on dermoscopy and RCM at five centres, from June 2007 to April 2020. Lesions were classified according to histopathological diagnoses of nevi, lentigo maligna melanoma (LM/LMM) or superficial spreading melanoma (SSM). Clinical, dermoscopic and RCM images were evaluated; LM/LMM and SSM subtypes were compared through multivariate analysis.ResultsTwo hundred forty‐seven lesions were included. In situ melanomas were mostly LM (81.3%), while invasive melanomas were mostly SSM (75.8%). Male sex, baldness and chronic sun‐damaged skin were associated with all types of melanomas and in particular with LM/LMM. LMs were mostly located in the vertex area and SSM in the frontal (OR: 8.8; P < 0.05, CI 95%) and temporal (OR: 16.7; P < 0.005, CI 95%) areas. The dermoscopy presence of pseudo‐network, pigmented rhomboidal structures, obliterated hair follicles and annular–granular pattern were associated with LM diagnoses, whereas bluish‐white veil was more typical of SSM. Observations on RCM of atypical roundish and dendritic cells in the epidermis were associated with SSM (42.4%) and dendritic cells with LM (62.5%) diagnoses. Folliculotropism on RCM was confirmed as a typical sign of LM.ConclusionsFlat scalp melanomas reveal specific dermoscopic and RCM features according to histopathologic type and scalp location.

17502 Melanomas of the scalp: Is hair coverage preventing early diagnosis?

Background: Scalp melanomas are usually thicker and show worse prognosis than other sites. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions.

Dermoscopic features of a primary scalp melanoma and its cutaneous metastases.

Dermoscopic features of a primary scalp melanoma and its cutaneous metastases.

Melanomas of the scalp: is hair coverage preventing early diagnosis?

Scalp melanomas are usually thicker and show worse prognosis than other sites and other head and neck melanomas. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions. Primary melanomas of the scalp diagnosed over two decades at four reference centers in Australia and Italy were included. Hair coverage and visibility of the lesions were assessed on preoperative photographic documentation by two investigators and correlated with some prognostic factors (Breslow thickness, mitotic rate, and ulceration). Patients records and pathology reports provided clinical and histological data. The majority of 113 melanomas included were located on easily visible areas of the scalp - hairless scalp (49%) or hairline (15%). The remaining ones (36%), considered to be hair-covered, showed more frequently thinning of hair (63%) than a dense hair coverage (37%). Melanomas of "hairy scalps" were more frequently invasive (81%) and had higher median Breslow (0.8±1.3mm) than those arising on bald scalps or areas with thinning of hair (43%; 0±0.6mm), P=0.004. However, when considering only the invasive cases (n=55), Breslow thickness and mitotic rate were not statistically different between concealed and easily visible areas. Melanomas detected by a doctor were thinner than those first noticed by the patient, relatives, or a hairdresser (P<0.001). Most scalp melanomas arose on easily visible areas, which are more prone to ultraviolet damage. Hair-covered ones, despite rare, could be overlooked during examination. Proactive screening of the scalp area should be encouraged.

Primary cutaneous melanoma of the scalp: Patterns of clinical, histological and epidemiological characteristics in Brazil.

Scalp melanoma is a subgroup of melanomas on the head and neck, historically associated with worst prognosis. Knowledge of the usual presentation of scalp melanoma can help to understand the reasons for the poor outcomes of treatment. This is the first publication to describe the clinical, histopathological and epidemiological profile of patients with scalp melanoma in a Latin American population. A cross-sectional study was performed of all primary cutaneous melanoma seen by the A.C.Camargo Cancer Center between 2008 and 2018, using an electronic health records to access clinical and pathology data. When compared to trunk and limbs, increasing age is expected for patients with scalp melanoma (10.865; CI (95%) = [8.303; 13.427]). Regarding risk of invasion, scalp melanomas have a higher chance to be invasive than in situ (OR = 1.783; CI (95%) = [1.196; 2.657]) and present with higher Breslow thickness (OR = 3.005; CI (95%) = [2.507; 3.601]). Scalp site was significantly associated with male sex (OR = 3.750; CI (95%) = [2.533; 5.554]), perineural invasion (OR = 13.739; CI (95%) = [5.919; 31.895]), ulceration (OR = 2.311; CI (95%) = [1.488; 3.588]), and mitosis (OR = 2.366; CI (95%) = [1.701; 3.292]), when compared to trunk and limbs melanoma. In the present study, head and neck melanomas represented 14.9% of all melanomas, a frequency slightly lower than that described in the literature and the mean age of melanoma on the scalp found was lower than that reported in the literature. These results could be explained by the demographic characteristics of Brazil, which has a population with a lower life expectancy compared to the European and North American population. Scalp melanomas occurred in older men, were diagnosed with greater Breslow thickness and were associated with the presence of perineural invasion, mitosis and ulceration.

IMMUNE CHECK POINT INHIBITOR-INDUCED ORGANIZING PNEUMONIA IN A LUNG TRANSPLANT PATIENT

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Immune check point inhibitors (ICI) are an effective therapy in treatment of multiple malignancies. Ipilimumab, a CTLA-4 antibody was the first ICI to be approved for advanced melanoma, followed by pembrolizumab, a PD1 inhibitor(1)(2). A myriad of immune related adverse effects have been observed with use of checkpoint inhibitors, due to T cell activation. ICI up regulate immune response to cancer but also leads to rejection of transplanted organs. Here we present a case of ICI pneumonitis after treatment with pembrolizumab in a lung transplant patient. CASE PRESENTATION: An 80-year-old Caucasian male received bilateral lung allografts in 2003 for idiopathic pulmonary fibrosis. In 2014, he was diagnosed with malignant melanoma and squamous cell carcinoma of scalp and neck, and underwent wide local excision with radiation therapy. He received two cycles of pembrolizumab for recurrence of melanoma (BRAF wildtype) after which he developed acute hypoxemic respiratory failure requiring mechanical ventilation. The patient received broad spectrum antibiotics and pulse dose methyl prednisolone for suspected transplant rejection. Bronchoalveolar lavage showed bilateral alveolar hemorrhage and trans-bronchial biopsies of the left lower lobe and lingula showed acute organizing pneumonia. With the concern for ICI pneumonitis versus ICI induced rejection of lung allograft the patient was treated with pulse dose steroids and then a prolonged steroid taper. DISCUSSION: Multiple adverse events have been reported with ICI including pulmonary toxicity. In a meta-analysis of 6360 patients, the incidence of pneumonitis from anti-PD-1 immunotherapy was 2.92% (3). Increased T-cell activity, inflammatory cytokines, and enhanced complement-mediated inflammation is suggested as the mechanism. ICI pneumonitis may manifest as cryptogenic organizing pneumonia, interstitial pneumonia, hypersensitivity pneumonitis, or acute respiratory distress syndrome patterns (4). Lung toxicities are graded dependent on severity of symptoms and extent of radiological involvement and American Society of Clinical Oncology provides expert consensus on treatment recommendations. Current guidelines indicated the discontinuation of ICI and initiation of corticosteroids in our patient with grade 3 toxicity. In refractory cases, anti-TNF-a agent infliximab, has been used. Allograft rejection must also be considered in lung transplant patients who undergo ICI therapy. Infectious pneumonia must also be excluded as this can be fatal if left untreated (5). CONCLUSIONS: Our patient presented with ICI related organizing pneumonia in transplanted lungs, which has been reported in few case reports with favorable response to high dose steroids. Awareness of potential complications of ICI especially in transplant population facilitates early recognition and prompt treatment with improved outcomes. Reference #1: 1) Alexander W. The Checkpoint Immunotherapy Revolution: What Started as a Trickle Has Become a Flood, Despite Some Daunting Adverse Effects; New Drugs, Indications, and Combinations Continue to Emerge. P T. 2016;41(3):185–191. Reference #2: 2) Robert, C., Schachter, J., Long, G. V., Arance, A., Grob, J. J., Mortier, L., … Ribas, A. (2015). Pembrolizumab versus Ipilimumab in Advanced Melanoma. New England Journal of Medicine, 372(26), 2521–2532. doi: 10.1056/nejmoa1503093 Reference #3: 3) Nishino M, Giobbie-Hurder A, Hatabu H, Ramaiya NH, Hodi FS. Incidence of Programmed Cell Death 1 Inhibitor–Related Pneumonitis in Patients With Advanced Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2016;2(12):1607–1616. doi:10.1001/jamaoncol.2016.2453 4) Nishino, M., Giobbie-Hurder, A., Hatabu, H., Ramaiya, N. H., & Hodi, F. S. (2016). Incidence of Programmed Cell Death 1 Inhibitor–Related Pneumonitis in Patients With Advanced Cancer. JAMA Oncology, 2(12), 1607. doi: 10.1001/jamaoncol.2016.2453 5) Jun, J., Lee, S. R., Lee, J. Y., Choi, M. J., Noh, J. Y., Cheong, H. J., … Song, J. Y. (2019). Pneumonitis and concomitant bacterial pneumonia in patients receiving pembrolizumab treatment: Three case reports and literature review. Medicine, 98(25), e16158. doi:10.1097/MD.000000000001615 DISCLOSURES: no disclosure on file for Deepa Gotur; No relevant relationships by Uchenne Mbaraonye, source=Web Response no disclosure on file for Cindy Nguyen; no disclosure on file for Lily Romero Karam; Speaker/Speaker's Bureau relationship with Astellas Pharma US, Inc. Please note: $1001 - $5000 Added 03/10/2020 by Simon Yau, source=Web Response, value=Salary

A brief synopsis on scalp melanoma.

Melanoma constitutes one of the most sinister and troublesome malignancies encountered by humanity. Generally, the diagnosis of advanced melanoma connotes a grave prognosis, prompting a sense of looming threat of death, however, the early-stage detected disease responds well to robust treatment resulting in reasonable survivorship. Scalp melanomas are even more troublesome, because they typically exhibit more aggressive biologic behavior and are often diagnosed at a late stage. This review tries to comprehensively highlight the various diagnostic, therapeutic, and outcome aspects of scalp melanomas. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till May 2020 and reference lists of respective articles. Only articles published in English language were included.