Definitive treatment with PD-1 blockade and radiation therapy of unresected primary desmoplastic melanoma of the nose

Two patients with primary desmoplastic melanoma of the nose were treated with definitive anti-PD-1 checkpoint inhibitor (anti-PD1) and radiation therapy. Both patients were technically resectable with partial rhinectomy but both declined for cosmetic reasons. The melanoma multidisciplinary team recommended that the patients receive PD1 blockade. The initial response to PD-1 blockade was temporary in the first case and partial in the second one. With the addition of high-dose radiotherapy, complete responses were obtained in both patients, with recurrence-free and good functional and cosmetic outcomes at a six-year and 22-month follow-up. Despite surgery being the gold standard, both cases illustrated that PD-1 blockade and radiation therapy can be a safe alternative option for desmoplastic melanoma where surgery is morbidly disfiguring.