Approximately 200,000 new cases of melanoma are diagnosed worldwide each year.,Skin metastases are a frequent event, occurring in 18.2% of cases.,This can be distressing for the patient, as the number and size of cutaneous lesions increases, often worsened by ulceration, bleeding and pain.,Electrochemotherapy (ECT) is a local modality for the treatment of cutaneous or subcutaneous tumors that allows delivery of low- and non-permeant drugs into cells.,ECT has been used in palliative management of metastatic melanoma to improve patients’ quality of life.,This is, to our knowledge, the first application of ECT as neoadjuvant treatment of metastatic subcutaneous melanoma.,A 44-year-old Caucasian woman underwent extensive surgical resection of a melanoma, with a Breslow thickness of 1.5 mm, located on the right side of her scalp.,No further treatment was given and the woman remained well until she came to our attention with a large nodule in her right cheek.,Whole-body fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) was performed for staging and treatment monitoring.,Baseline FDG PET/CT showed the lesion in the cheek to have a maximal standardized uptake value (SUVmax) of 19.5 with no evidence of further disease spread.,Fine needle aspiration cytology confirmed the presence of metastatic melanoma.,The patient underwent two sessions of ECT with intravenous injections of bleomycin using a CliniporatorTM as neoadjuvant treatment permitting conservative surgery three months later.,Follow-up PET/CT three months after the first ECT treatment showed a marked decrease in SUVmax to 5.,Further monitoring was performed through monthly PET/CT studies.,Multiple cytology examinations showed necrotic tissue.,Conservative surgery was carried out three months after the second ECT.,Reconstruction was easily achieved through a rotation flap.,Pathological examination of the specimen showed necrotic tissue without residual melanoma.,One year after the last ECT treatment, the patient was disease-free as determined by contrast-enhanced CT and PET/-CT scans with a good functional and aesthetic result.,ECT represents a safe and effective therapeutic approach that is associated with clear benefits in terms of quality of life (minimal discomfort, mild post-treatment pain and short duration of hospital stay) and may, in the neoadjuvant setting as reported here, offer the option of more conservative surgery and an improved cosmetic effect with complete local tumor control.
Electrochemotherapy treats tumors by combining specific chemotherapeutic drugs with an intracellular target and electric pulses, which increases drug uptake into the tumor cells.,Electrochemotherapy has been successfully used for treatment of easily accessible superficial tumor nodules.,In this paper, we present the first case of deep-seated tumor electrochemotherapy based on numerical treatment planning.,The aim of our study was to treat a melanoma metastasis in the thigh of a patient.,Treatment planning for electrode positioning and electrical pulse parameters was performed for two different electrode configurations: one with four and another with five long needle electrodes.,During the procedure, the four electrode treatment plan was adopted and the patient was treated accordingly by electrochemotherapy with bleomycin.,The response to treatment was clinically and radiographically evaluated.,Due to a partial response of the treated tumor, the metastasis was surgically removed after 2 months and pathological analysis was performed.,A partial response of the tumor to electrochemotherapy was obtained.,Histologically, the metastasis showed partial necrosis due to electrochemotherapy, estimated to represent 40-50% of the tumor.,Based on the data obtained, we re-evaluated the electrical treatment parameters in order to correlate the treatment plan with the clinical response.,Electrode positions in the numerical model were updated according to the actual positions during treatment.,We compared the maximum value of the measured electric current with the current predicted by the model and good agreement was obtained.,Finally, tumor coverage with an electric field above the reversible threshold was recalculated and determined to be approximately 94%.,Therefore, according to the calculations, a small volume of tumor cells remained viable after electrochemotherapy, and these were sufficient for tumor regrowth.,In this, the first reported clinical case, deep-seated melanoma metastasis in the thigh of the patient was treated by electrochemotherapy, according to a treatment plan obtained by numerical modeling and optimization.,Although only a partial response was obtained, the presented work demonstrates that treatment of deep-seated tumor nodules by electrochemotherapy is feasible and sets the ground for numerical treatment planning-based electrochemotherapy.,EudraCT:2008-008290-54