PMC8554100_01
(A) Timeline of therapy and disease status for both melanoma and MG. (B) PET/CT findings at melanoma relapse and at the last follow-up. (C) MRI findings at melanoma brain metastasis diagnosis and at 3.5 years after stereotactic radiosurgery. (D) The results of RNS test in the right deltoid muscle and the right trapezoid muscle at the time of clinical presentation of myasthenia gravis.
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A 57-year-old Caucasian woman, living in Athens with her husband, with no past medical history was diagnosed in November 2011 with a stage Ib cutaneous melanoma at her chest wall (pT3bN0, Breslow 3.65 mm, Clark IV, with presence of ulceration) and negative sentinel lymph node dissection (SLND) (0 of 5) in her right axilla ( Figure 1A ). PET/CT scan showed abnormal hypermetabolic activity of this axillary lymph node lesion (maximum standardized uptake value, SUVmax = 9.4) with no evidence of active disease elsewhere ( Figure 1B ). Due to the BRAF (+) nature of melanoma, a magnetic resonance of her brain was scheduled at the end of the same month, revealing a synchronous small solitary melanoma metastasis in her left lobe ( Figure 1C ). In our case, the RNS test was totally consistent for MG, with decrease in motor voltage by 39% in the right deltoid muscle and with decrease in motor voltage by 22% in the right trapezoid muscle ( Figure 1D ).
PMC8554100_02
Flow diagram of literature search strategy, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 guidelines.
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The entire literature search was conducted by two independent investigators (CT and P-PL), and the selection of retrieved reports, with the numbers of the records identified or excluded and the reasons of exclusions, is represented in  Figure 2 .