Fig. 2.

Successful use of pembrolizumab in a patient with widely metastatic melanoma. Patient is 61-year-old with widely metastatic melanoma refractory to several lines of systemic treatment. Per discussion with medical oncology team, the consensus was for systemic treatment. Panel A demonstrates several sites of bulky metastatic disease (arrows) and a large spinal metastasis at T11 (circle) treated with spinal stereotactic radiosurgery 3 months prior to starting anti-programmed-death 1 therapy. Panel B demonstrates complete resolution of the bulky metastatic disease including the epidural spinal cord compression 8 months after treatment with pembrolizumab. The patient currently remains disease free with a follow-up of 90 months.