case_images: PMC4622667_01
case_images: Patient 1. PET/CT in 12/12 (left, prior to vemurafenib) showed innumerable intensely FDG avid lymph nodes and soft tissue deposits scattered throughout the body which developed during her course of ipilimumab by 2 cycles. PET/CT in 2/13 (right, after starting vemurafenib and completion of the ipilimumab course) showed the previously described intensely FDG avid metastases had entirely resolved. The vemurafenib was weaned and completely stopped by 12/13. She has remained in complete remission to date off all therapy.
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case_images: The patient was then started on ipilimumab, but had marked progressive disease after 2 cycles, as shown by PET/CT in December 2012 (Fig. 1 left). PET/CT scan in February 2013, 3 months after the vemurafenib therapy, showed CR (Fig. 1, right).
case_images: Vitiligo of right arm in Patient 1. The photo shows patchy depigmentation of skin after the patient was treated with vemurafenib but this process had actually started after completion of high dose IL-2.
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case_images: The patient did not develop autoimmune hepatitis but her vitiligo became more prominent (Fig. 2) and she also developed autoimmune hypophysitis, which required hydrocortisone replacement.
case_images: PMC4622667_02
case_images: Patient 2. PET/CT on 3/13 (left, prior to vemurafenib) showed intensely FDG avid lymph nodes and soft tissue deposits post ipilimumab. PET/CT on 6/13 (right, after vemurafenib) showed the previously described intensely FDG avid lymph nodes and nodules had entirely resolved. The vemurafenib was gradually weaned and stopped by 3/14. She has remained in complete remission to date off therapy.
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case_images: PET/CT scan showed extensive adenopathy in her left neck, axilla and mediastinum, consistent with an M1a pattern (Fig. 3, Left). Her arthritis gradually subsided over time, and she remains in complete remission 12 months from completion of the vemurafenib (Fig. 3, Right).
case_images: PMC4622667_03
case_images: Patient 3. PET/CT in August 2013 (left, prior to BRAF inhibitor therapy) showed intensely FDG avid lymph nodes post ipilimumab which were biopsy confirmed metastatic melanoma. PET/CT in November 2013(right, after trametinib) showed the previously described intensely FDG avid lymph nodes and nodules had entirely resolved. The skin nodules on his scalp also resolved. The trametinib was gradually weaned and stopped by 5/14. He has remained in complete remission to date off therapy.
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case_images: The patient reached CR by PET scan 3 months later (Fig. 4).