26th February 2025

An 89-year-old gentleman with metastatic melanoma has been treated by the oncology team

An 89-year-old gentleman with metastatic melanoma has been treated by the oncology team. He completed a course of treatment with ipilimumab and nivolumab immunotherapy 8 weeks earlier. He presents with headaches that have been slowly worsening over the last 3 weeks. He has also had a poor appetite due to persistent nausea and has lost 5 kg of weight in 6 weeks. He is opening his bowels daily and passing wind as normal.

On examination, his abdomen is soft and non tender, with active bowel sounds. On neurological examination, his GCS is 15, and he is alert and oriented. He has left arm and leg weakness, right arm sensory loss, and upgoing plantars bilaterally. He is unable to abduct either eye but otherwise, his cranial nerve examination is normal. Observations and blood tests are unremarkable.

His other past medical history includes hypercholesterolaemia, type II diabetes mellitus and hypertension.

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