over the past year , 3 agents have been approved for the treatment of melanoma by the food and drug administration .
these include pegylated interferon -2b for stage iii melanoma , vemurafenib for unresectable or metastatic melanoma with braf v600e mutation , and ipilimumab for unresectable or metastatic melanoma .
we present here the case of a 65-year - old caucasian male diagnosed with advanced melanoma in april 2011 and treated with ipilimumab ( yervoy ) , a monoclonal antibody targeting cytotoxic t - lymphocyte - associated antigen 4 ( ctla-4 ) , as second - line treatment after progression with dacarbazine , for ( wild - type braf ) metastatic melanoma .
the patient was started on first - line chemotherapy with dacarbazine 850 mg / m on day 1 , every 3 weeks .
after 3 cycles , the patient showed disease progression with an increase in size of the skin metastasis .
second - line treatment was started with ipilimumab 3 mg / kg on day 1 , every 3 weeks . at the end of the treatment , after 4 cycles , we documented a complete clinical response with total resolution of the skin metastasis . at the time of writing this paper ,
our patient had finished his treatment more than 9 months earlier and is still in complete remission .
this is a paradigmatic case where , despite extensive metastatic disease , treatment with ipilimumab has confirmed its efficacy .
it is still an open question why only a minority of patients have such a remarkable response , and further trials are warranted to address this important question .
about 200,000 cases of melanoma are diagnosed and 48,000 melanoma - related deaths occur worldwide each year . among cancers in patients under 40 years of age , the incidence of melanoma is second only to that of breast cancer in women and leukemia in men .
since 2010 , a real breakthrough has occurred in advanced melanoma therapy that had been anticipated for decades .
molecular targeted therapy has been added to the treatment regimen of this disease . before 2010
, no systemic therapy had been shown to improve overall survival among patients with metastatic melanoma .
ipilimumab , a monoclonal antibody targeting cytotoxic t - lymphocyte - associated antigen 4 ( ctla-4 ) , and vemurafenib , a selective braf inhibitor , have both been shown to improve survival among patients with metastatic melanoma in randomized trials [ 3 , 4 , 5 ] . here ,
we present the case of a 65-year - old caucasian male diagnosed with advanced melanoma in april 2011 and treated with ipilimumab , after dacarbazine failed , for ( wildtype braf ) metastatic disease .
the patient was referred to us in april 2011 , presenting with several painful exophytic lesions on his right arm ( fig . 1 , fig .
no evidence of any primary tumors was found despite confirmation of multiple lumps in his right arm .
the patient was started on dacarbazine 850 mg / m on day 1 , every 3 weeks , but after 3 cycles he experienced disease progression with nearly all previous lesions increasing in size and a new one popping up .
he was then started on ipilimumab 3 mg / kg and , after the whole treatment consisting of 4 cycles , which he tolerated very well , he achieved a complete clinical ( fig .
the latest ct scan ( performed at the end of march 2013 ) did not show any metastatic disease .
molecular targeted therapies ( e.g. braf inhibitors ) have reached high response rates but , unfortunately , rather short response duration ( progression - free survival : 6 months ) , while immunotherapy has shown slower but more durable results .
reported that ipilimumab ( 3 mg / kg every 3 weeks or an initial dose of 3 mg / kg then 1 mg / kg every 3 weeks ) plus a peptide vaccine resulted in 2 complete responses and 5 partial responses among 56 patients with progressive stage iv melanoma .
it is rare but not impossible to achieve a complete response , and some patients are currently in a state of complete response . to date , our patient has been free from cancer for 9 months . written informed consent was obtained from the patient for publication of this work and accompanying images .
a copy of the written consent form is available for review from the editor - in - chief of this journal .
this is a paradigmatic case where , despite extensive metastatic disease , the treatment with ipilimumab has confirmed its efficacy .
it is still an open question why only a minority of patients have such a remarkable response , and further trials are warranted to address this important question .
understanding the biology of melanoma is crucial for an accurate selection of patients who will be more likely to benefit from ipilimumab .
 introductionover the past year , 3 agents have been approved for the treatment of melanoma by the food and drug administration . 
 these include pegylated interferon -2b for stage iii melanoma , vemurafenib for unresectable or metastatic melanoma with braf v600e mutation , and ipilimumab for unresectable or metastatic melanoma.case presentationwe present here the case of a 65-year - old caucasian male diagnosed with advanced melanoma in april 2011 and treated with ipilimumab ( yervoy ) , a monoclonal antibody targeting cytotoxic t - lymphocyte - associated antigen 4 ( ctla-4 ) , as second - line treatment after progression with dacarbazine , for ( wild - type braf ) metastatic melanoma . 
 the patient was referred to us for several painful lumps on his right arm . 
 a biopsy of one of them revealed melanoma . 
 ct and pet scans did not show any other lesions or a primary site . 
 the patient was started on first - line chemotherapy with dacarbazine 850 mg / m2 on day 1 , every 3 weeks . 
 after 3 cycles , the patient showed disease progression with an increase in size of the skin metastasis . 
 second - line treatment was started with ipilimumab 3 mg / kg on day 1 , every 3 weeks . at the end of the treatment , after 4 cycles , we documented a complete clinical response with total resolution of the skin metastasis . at the time of writing this paper , 
 our patient had finished his treatment more than 9 months earlier and is still in complete remission.conclusionthis is a paradigmatic case where , despite extensive metastatic disease , treatment with ipilimumab has confirmed its efficacy . 
 it is still an open question why only a minority of patients have such a remarkable response , and further trials are warranted to address this important question . 
Introduction
Case Presentation
Conclusion
Introduction
Case Report
Conclusion
Disclosure Statement