Targeted Therapy and Immunotherapy in the Treatment of Metastatic Cutaneous Melanoma

Saro Sarkisian, MD

Clinical Assistant Professor, Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Corey Rearick, BSc

University of Pittsburgh School of Medicine, Pittsburgh, PA

Diwakar Davar, MD, MSc

Assistant Professor, Melanoma and Phase I Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA

Question 11

A 77-year old Caucasian man presents with a pigmented lesion on the scalp. Pathology from a shave biopsy reveals a 2.60-mm Breslow, Clark level III, focally ulcerated, superficial spreading melanoma with 1 mitosis/mm2, partial regression, moderate tumor-infiltrating lymphocytes (TIL) with no evidence of satellitosis or angiolymphatic or perineural invasion. Margins are clear but close at 0.5 mm. Wide local excision and sentinel lymph node biopsy are planned.

Which of the following mutations is most likely to be found on genetic analysis of the primary specimen?

  •   GNA11 c.547C>T (R183C) mutation
  •   NRAS c.38G>T (G13V) mutation
  •   KRAS c.34G>T (G12C) mutation
  •   PIK3CA c.1624G>A (E542K) mutation
  •   SMAD4 c.1081C>T (R361C) mutation

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