Corresponding author: Yang Qiu’an, Email: [email protected]患者男, born in August 1974, a peanut-sized nevus on the right abdominal wall was found in August 2003, and was then locally enlarged and resected, with no special treatment after the operation.She was consulted for a right axillary mass in September 2005, and was examined at that time with no localized pain, no redness or swelling of the surrounding skin, and nipple At that time, there was no pain in the area, no redness or swelling of the surrounding skin, and the nipple was not overflowing with fluid. Postoperative histopathological examination diagnosed metastatic malignant melanoma in the lymph nodes and connective tissues of the right axilla. Postoperative PET/CT examination of the whole body showed no obvious metastatic foci, and expanded lymph node dissection of the right axilla was performed on October 13, 2005, and postoperative histopathological examination showed that no tumors were detected in any of the five axillary lymph nodes. After the operation, interleukin-2 treatment (2 million IU/dose, subcutaneous injection, 1, 3, 5 every week, 4 weeks for 1 cycle) was given for 4 cycles, and in January 2006, a left inguinal mass was found, which was about 3cm×2cm in size, tough, and with limited movement. Examination revealed a left supraclavicular enlarged lymph node, maximum 2cm×1cm, tough, with restricted movement. After consultation and consultation and with the patient’s consent, concurrent radiotherapy treatment was given. Gemcitabine combined with azelnimidamide regimen was used for chemotherapy, with gemcitabine 1000mg/m2/d, intravenous drip on day 1 and day 8, and azelnimidamide 200mg/m2/d, intravenous drip from day 1 to day 4 in each cycle, with a total of 4 cycles of chemotherapy in 21 days; radiation therapy was given to the right axilla, the left supraclavicular and the left inguinal regions on the 1st day of the 1st cycle of chemotherapy, with 6 MV X-ray in all fields, and radiation therapy was given to the left supraclavicular area and the left supraclavicular area. Each field was irradiated with 6 MV X-ray, routinely segmented (200 cGy of tumor per field per time (DT), irradiated 5 times per week), and irradiated the right armpit 20 times/4 weeks, the left supraclavicular and left inguinal areas 30 times/6 weeks each. 1 month after the treatment, the review showed that the enlarged lymph nodes completely disappeared, and the clinical evaluation was a complete remission (CR). After radiotherapy, the skin of the right axilla broke down with a small amount of viscous exudation, which was evaluated as a III-degree radiotherapy reaction; the skin of the right groin was red and swollen, with a little dry desquamation, which was evaluated as a II-degree radiotherapy reaction. The skin gradually returned to normal 2 months after radiotherapy after treatment with comfrey oil and epidermal growth factor spray and appropriate antibiotic therapy. Yang Qiu’an, Department of Radiotherapy, Qilu Hospital, Shandong University, the patient was rechecked every 3 months for the first two years after treatment, and every 6 months after two years, and the last recheck date was January 22, 2011, the patient’s general condition was good, with normal life and work, and the physical strength condition (PS) score was normal (0 points). The patient’s blood tests were normal, no lymph node enlargement was found in bilateral neck, axillary, and groin ultrasound examinations, and there were no abnormalities in chest and abdominal CT examinations. DISCUSSION Malignant melanoma originates from melanin-producing melanocytes that migrate to the skin and eyes during embryonic development. Melanoma is most common in males, with a peak age of onset around 50 years [1]. Melanomas may originate from dysplastic nevi, and a few have a family history. Approximately 5% of patients present with regional lymph node involvement or distant metastases of unknown origin, about 25% develop visceral metastases, and about 15% develop only lymph node metastases [1]. In this case, according to the American Cancer Consortium (AJCC) cancer staging, the staging was M1a, stage IV, with metastases in the right axilla, left inguinal and left supraclavicular lymph nodes, and the patient was cured for 5 years after the complete disappearance of the lesions by using rational concurrent radiotherapy. The treatment of malignant melanoma includes surgery, chemotherapy, radiotherapy and biotherapy. The treatment of early malignant melanoma is based on surgery and has a good prognosis, but metastatic malignant melanoma has a poor prognosis due to the lack of sensitivity to radiotherapy, chemotherapy, and biotherapy, with a median survival period of 6 to 9 months and a 5-year survival rate of <5%[2] . There is no standard combination chemotherapy regimen, and azelnidazole is the main drug for the treatment of metastatic malignant melanoma, with a single-agent efficacy rate of approximately 15% to 20%. Gemcitabine inhibits the activity of ribonucleotide reductase, which acts on the DNA phase (S phase) of tumor cells to inhibit DNA synthesis and promote cell death and apoptosis; several studies have reported[3, 4, 5] that gemcitabine treats advanced malignant melanoma with good efficacy. Gemcitabine also has a defined radiosensitizing effect [6, 7], and its sensitizing mechanism includes: ① Gemcitabine can inhibit the repair of DNA damage after radiotherapy, resulting in increased cell death; ② Gemcitabine can induce cell blockade in the G-phase, which puts the cells in the cell cycle that is more sensitive to radiation, and increases the ability of radiation to kill the tumor cells; ③ Gemcitabine acts in the S-phase, which is resistant to radiation, and increases the efficacy of the therapy; ④ Gemcitabine Gemcitabine depletes purine triphosphate deoxyribonucleotide dATP and inhibits DNA synthesis. 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