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Case Report Open Access

Systemic treatment for a young patient with stage IV melanoma: A case report

  • Authors:
    • Xiaoyu Huang
    • Lianhai Zhao
    • Pingan Wang
    • Dong Xue
  • View Affiliations / Copyright

    Affiliations: Graduate School, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Hepatobiliary Surgery, Binzhou People's Hospital Affiliated to Shandong First Medical University, Binzhou, Shandong 256610, P.R. China
    Copyright: © Huang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 82
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    Published online on: December 19, 2025
       https://doi.org/10.3892/ol.2025.15435
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Abstract

Melanoma is a highly malignant tumor with a marked propensity for metastasis, and liver metastasis in particular is consistently associated with a poor prognosis. The current study reports the case of a 24‑year‑old man who presented with multiple systemic metastases 3 years after undergoing radical resection of a cutaneous melanoma. Genetic testing identified a BRAF mutation, which led to the initiation of targeted therapy using dabrafenib in combination with trametinib. After 2 months of treatment, imaging revealed a partial response in the liver metastases. However, by the fourth month, the disease progressed rapidly due to acquired resistance, causing the patient to succumb to liver failure and multiple organ dysfunction. The present case highlights the key need for vigilance, as even young patients with early‑stage melanoma remain at risk of rapid disease progression. Therefore, implementing rigorous postoperative patient education and follow‑up protocols is key to the early detection of recurrence and timely intervention. Simultaneously, the present case illustrates the challenge of acquired resistance to targeted therapy, underscoring the importance of developing strategies to overcome such resistance to potentially improve patient survival in the future.
View Figures

Figure 1

Histopathology of the primary
cutaneous melanoma mass. Under light microscopy, tumor cells
exhibit diffuse growth, marked variation in size and shape,
abundant cytoplasm, nuclear pleomorphism (yellow arrows), prominent
nucleoli (blue arrows) and melanin pigment (red arrows) within and
between tumor cells. (A) Low-power view (magnification, ×100). (B)
High-power view (magnification, ×200).

Figure 2

Endoscopic findings of metastatic
melanoma. (A) Pharynx. Endoscopy demonstrates diffuse melanosis,
evident as black mucosal discoloration. (B-E) Esophagus. Serial
endoscopic views reveal extensive, multifocal melanin pigmentation.
(B) Esophagus showing extensive melanin pigmentation. (C) Esophagus
revealing scattered, multifocal melanin deposits. (D) Esophagus
displaying patchy areas of melanin pigmentation. (E) Esophagus
demonstrating sheet-like melanosis. (F) Gastric body. A pigmented,
broad-based, elevated lesion measuring ~0.5 cm in diameter is seen,
consistent with a metastatic deposit.

Figure 3

Histopathological and
immunohistochemical features of metastatic melanoma. (A-D)
Esophageal metastasis. (A) H&E stain shows tumor cell nests.
(B) CK-Pan negative (red arrows indicate tumor cells). (C) HMB-45
positive (magnification, ×200). (D) Melan-A positive
(magnification, ×100). (E-H) Gastric metastasis. (E) H&E
morphology of the metastatic deposit (magnification, ×200). (F)
CK-Pan negative (magnification, ×100). (G) HMB-45 positive. (H)
Melan-A positive (magnification, ×200). H&E, Hematoxylin and
eosin; HMB, human melanoma black; CK-Pan, Pan-cytokeratin.

Figure 4

Abdominal CT scan (November 2024).
Multiple metastatic lesions (yellow arrows) are present throughout
the liver. (A) Arterial phase CT demonstrating the metastatic
lesions (yellow arrows) compressing the inferior vena cava (red
arrow). (B) Venous phase CT showing the metastatic lesions (yellow
arrows) compressing the inferior vena cava (red arrow). (C) Delayed
phase CT revealing the metastatic lesions (yellow arrows)
compressing the inferior vena cava (red arrow). (D) Arterial phase
CT showing the metastatic mass (yellow arrows) compressing both the
portal vein (blue arrow) and inferior vena cava (red arrow). (E)
Venous phase CT demonstrating the metastatic mass (yellow arrows)
compressing both the portal vein (blue arrow) and inferior vena
cava (red arrow). (F) Delayed phase CT showing persistent the
metastatic mass (yellow arrows) compressing both the portal vein
(blue arrow) and inferior vena cava (red arrow). P, posterior.

Figure 5

Chest CT scan (November 2024).
Multiple metastatic nodules are visible in both lungs, with larger
lesions located in (A and B, red arrows) the left upper lobe
anterior segment and (C and D, yellow arrows) the right lower lobe
basal segment. (A) Mediastinal window CT demonstrating a larger
metastatic lesion (red arrow) in the left upper lobe anterior
segment. (B) Lung window CT showing the same metastatic nodule (red
arrow) with clear visualization of its relationship to the
surrounding pulmonary parenchyma. (C) Mediastinal window CT
revealing a larger metastatic lesion (yellow arrow) in the right
lower lobe basal segment. (D) Lung window CT displaying the same
metastatic nodule (yellow arrow) with optimal demonstration of its
pulmonary context. P, posterior.

Figure 6

Brain MRI (November 2024). Multiple
metastatic foci can be observed, with the largest lesion (red
arrows) situated in the left frontal lobe. Images are displayed in
(A) axial, (B) sagittal and (C) coronal planes. P, posterior; I,
inferior.

Figure 7

Serial changes in segment 6 liver
metastases during targeted therapy. (A and B) In November 2024, the
first follow-up scan after treatment initiation revealed tumor
burden. (A) Image showing metastatic lesions in segment 6 after
treatment initiation. (B) Adjacent slice demonstrating the tumor
burden in the same region. (C and D) Follow-up in January 2025
demonstrated a partial response after dabrafenib and trametinib
therapy. (C) Follow-up image revealing reduced tumor size following
dabrafenib and trametinib therapy. (D) Adjacent slice confirming
treatment response. (E and F) Subsequent imaging in February 2025
revealed disease progression (yellow arrows indicate lesions). (E)
Subsequent imaging showing recurrent lesion growth (yellow arrows)
indicating disease progression. (F) Adjacent slice confirming
disease progression with enlarging metastases (yellow arrows).

Figure 8

Clinical timeline summarizing the
disease course. The schematic illustrates the progression from
initial stage IA diagnosis through targeted therapy initiation,
transient treatment response and subsequent rapid progression
culminating in hepatic failure and mortality. TACE, transcatheter
arterial chemoembolization.
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Copy and paste a formatted citation
Spandidos Publications style
Huang X, Zhao L, Wang P and Xue D: Systemic treatment for a young patient with stage IV melanoma: A case report. Oncol Lett 31: 82, 2026.
APA
Huang, X., Zhao, L., Wang, P., & Xue, D. (2026). Systemic treatment for a young patient with stage IV melanoma: A case report. Oncology Letters, 31, 82. https://doi.org/10.3892/ol.2025.15435
MLA
Huang, X., Zhao, L., Wang, P., Xue, D."Systemic treatment for a young patient with stage IV melanoma: A case report". Oncology Letters 31.2 (2026): 82.
Chicago
Huang, X., Zhao, L., Wang, P., Xue, D."Systemic treatment for a young patient with stage IV melanoma: A case report". Oncology Letters 31, no. 2 (2026): 82. https://doi.org/10.3892/ol.2025.15435
Copy and paste a formatted citation
x
Spandidos Publications style
Huang X, Zhao L, Wang P and Xue D: Systemic treatment for a young patient with stage IV melanoma: A case report. Oncol Lett 31: 82, 2026.
APA
Huang, X., Zhao, L., Wang, P., & Xue, D. (2026). Systemic treatment for a young patient with stage IV melanoma: A case report. Oncology Letters, 31, 82. https://doi.org/10.3892/ol.2025.15435
MLA
Huang, X., Zhao, L., Wang, P., Xue, D."Systemic treatment for a young patient with stage IV melanoma: A case report". Oncology Letters 31.2 (2026): 82.
Chicago
Huang, X., Zhao, L., Wang, P., Xue, D."Systemic treatment for a young patient with stage IV melanoma: A case report". Oncology Letters 31, no. 2 (2026): 82. https://doi.org/10.3892/ol.2025.15435
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