Nodule on the left cheek
Often mistaken for a cyst or acneiform lesion, this lesion is actually quite aggressive—and worrisome.
Melanoma manifests with brown or irregular pigmentation and may be associated with a precursor lesion.
Tx includes excision and consistent follow-up
Complete excision is the critical first step to successful therapy. Sentinel lymph node studies are typically performed because of the high incidence of lymph node metastasis. Frequent follow-up is required because of the high risk of recurrent or persistent disease.
Local recurrence usually occurs within 1 year of diagnosis in more than 40% of patients.5 Distant metastasis can be treated with a programmed cell death ligand 1 blocking agent (avelumab) or a programmed cell death protein 1 inhibitor (nivolumab or pembrolizumab).6
Our patient was referred to a regional cancer center for sentinel lymph node evaluation, where he was found to have nodal disease. The patient was put on pembrolizumab and received radiation therapy but showed only limited response. Seven months after diagnosis, he passed away from metastatic MCC.
