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BASICS IN DERMATOLOGIC SURGERY
Giant achromatic melanoma developing in a Nevus. Daily bread in my clinic is the management of cutaneous tumours. All types of cutaneous melanomas аre presented. Patients come from all European / neighbouring countries but also from the Middle East.
In my posts I will presented the most interesting and rare case from my clinical practice, hoping to help in some diagnostic and therapeutic decisions and to show our way of clinical management.

For advanced melanoma, treatment options include immunotherapy, targeted therapy, radiation therapy, and, less commonly, chemotherapy. A specific type of advanced melanoma, “giant nodular achromatic melanoma,” is a rare condition that can arise in giant congenital melanocytic nevi, and its treatment depends on the specifics of the case. The primary goal is to control the cancer and improve quality of life, often using a combination of therapies tailored to the individual’s situation.
Treatment options for advanced melanoma
Immunotherapy: These treatments harness the body’s immune system to fight cancer cells. Examples include checkpoint inhibitors like ipilimumab and nivolumab, as well as emerging cellular therapies like TIL therapy (tumor-infiltrating lymphocytes).
Targeted therapy: These drugs target specific genetic mutations in cancer cells, such as those in BRAF and MEK. Common combinations include dabrafenib plus trametinib or encorafenib plus binimetinib.
Radiation therapy: High-energy particles are used to damage and destroy cancer cells, and it can be effective for melanoma that has spread to other parts of the body.
Chemotherapy: This is less common now but may still be used, sometimes in combination with other treatments. Treatments can include systemic chemotherapy, or more localized methods like electrochemotherapy or isolated limb infusion.
Treatment for giant achromatic melanoma
Surgical resection: For melanomas that arise in giant congenital melanocytic nevi, surgical removal of the nevus is often recommended, sometimes as a “one-step” approach.
Multimodal therapy: The treatment plan will depend on the specific stage, location, and genetic features of the melanoma, often combining surgery with other systemic therapies like immunotherapy or targeted therapy.
Important considerations
A “Regenerative Medicine Advanced Therapy” designation is given to certain therapies like cellular therapies that show promise for treating specific conditions, such as advanced melanoma.
Treatment decisions are complex and should be made with a medical team to determine the best plan for a patient’s specific type of advanced melanoma.