{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:41:30Z","timestamp":1780605690351,"version":"3.54.1"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":195,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Oncological Medicine"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    The synchronous occurrence of melanomas of varying histological types is an uncommon event, with reported incidences ranging from 0.2% to 8.6%.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case Report:<\/jats:bold>\n                    We present the case of a patient diagnosed with Stage IIB nodular melanoma and Stage IIIC epithelioid cell melanoma within a 3\u2010month period. After surgical excision of both lesions, lymph node enlargement was observed in the obturator region, indicating metastatic spread. As a result, combined immunotherapy with nivolumab and ipilimumab was initiated. Nivolumab and ipilimumab were administered at doses of 1 and 3\u2009mg\/kg, respectively, every 3 weeks for a total of four doses. Thereafter, treatment was continued with nivolumab alone at a dose of 3\u2009mg\/kg every 2 weeks. The patient underwent three cycles of immunotherapy, initially combined with intravenous methylprednisolone, later transitioned to an oral regimen with dexamethasone. The patient initially demonstrated a favorable clinical response without adverse effects. However, after the third infusion, severe diarrhea developed, leading to daily fluid losses exceeding 8\u2009L and associated hypokalemia. Therefore, methylprednisolone was administered intravenously (2\u2009mg\/kg\/day). Additionally, the patient experienced a splenic infarction that resolved spontaneously without resulting in asplenia. At the most recent follow\u2010up evaluation, no lymph node enlargement was detected, and surveillance continues at 3\u2010month intervals.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Discussion:<\/jats:bold>\n                    Although rare, the simultaneous emergence of melanomas at distinct anatomical sites underscores the necessity for increased patient vigilance and comprehensive clinical monitoring to facilitate early detection and timely intervention.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Prompt initiation of targeted immunotherapy may improve patient prognosis and outcomes.\n                  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