Clinical considerations about the coexistence of melanoma and chroniclymphocytic leukemia in the era of targeted therapies triggered by rareclinical scenarios. A case series and review of the literature

摘要

The epidemiologic correlation of melanoma and chronic lymphocytic leukemia (CLL)has been the subject of several population studies. In the present article,through the presentation of five illustrative cases of patients with melanomaand CLL, several aspects of this complex relationship are highlighted, with afocus on the increased incidence of melanoma in patients with CLL, itsspeculated etiology, and the impact of CLL stage and disease duration on theincidence and prognosis of melanoma. Furthermore, the rare entity of thesynchronous diagnosis of melanoma and CLL in biopsied lymph nodes is discussed,along with its implications on the diagnostic and therapeutic procedures. Inaddition, the available data on the treatment choices in patients with melanomaand CLL are presented and the efficacy and safety of fludarabine, anti-CD20monoclonal antibodies, new targeted therapies for CLL, and checkpoint inhibitorsare further discussed. Finally, since no formal guidelines are available for themanagement of this group of patients, guidelines are proposed for skin-cancerscreening in patients with CLL, for the correct interpretation ofBRAF mutation analysis in lymph-node specimens with‘collision of tumors,’ and for the optimal use of imaging studies in thediagnosis of metastatic disease in patients with CLL and melanoma, while atreatment approach for such patients is also suggested. The information andproposed guidelines provided in the present article comprise a useful guide forphysicians managing such patients, focusing on diagnostic challenges andtherapeutic dilemmas posed by the coexistence of the two disease entities.