Vol 12, No 3 (2016)
Case report
Published online: 2016-08-31
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Heart metastasis in the course of melanoma

Aleksandra E. Danieluk, Joanna H. Mańdziuk, Marek Z. Wojtukiewicz, Ewa Sierko
Oncol Clin Pract 2016;12(3):97-101.

Abstract

Introduction. The majority of melanoma patients develop distant metastases, the most common locations being the liver, the bones, and the brain. Moreover, it is a neoplasm that involves the heart in an unusually high number of cases compared to other neoplasms. However, there is a wide disproportion between metastasis rate to the heart in autopsy studies and antemortem diagnoses.

Case report. A 78-year-old female patient presented with a nevus in the lumbar area, diagnosed as malignant melanoma. Six months after the procedure, bilateral metastases in inguinal lymph nodes and recrudescence in the post-procedural scar were surgically removed. Radiotherapy covering the area of affected lymph nodes was carried out. During the next two months, regional recurrence of melanoma and metastases to the lungs and liver were observed. Due to the cancer progression the patient underwent three courses of DTIC chemotherapy; however, new lesions in skin and subcutaneous tissue were discovered, so second-line chemotherapy with ipilimumab was commenced. An echocardiography performed at the time showed no abnormalities. Three months later an ECG showed negative T wave in V2–V4, and CT revealed progression in size of the existing lesions and a new lesion located in the heart, infiltrating the interventricular septum. The patient was referred to hospice care.

Conclusions. Since heart metastases are rarely diagnosed antemortem, raising awareness of possible cardiac involvement in the course of melanoma progression among physicians and radiologists is vital. It can lead to more diagnoses of cardiac metastases and therefore provide optimal care for the patients.

References

  1. Holm RP. Skin cancer prevention and screening. S D Med. 2015; Spec No: 75-77, 79-81.
  2. Tas F. Metastatic behavior in melanoma: timing, pattern, survival, and influencing factors. J Oncol. 2012; 2012: 647–684.
  3. Bhatia S, Tykodi SS, Thompson JA. Treatment of metastatic melanoma: an overview. Oncology (Williston Park). 2009; 23(6): 488–496.
  4. Fellner C. Ipilimumab (yervoy) prolongs survival in advanced melanoma: serious side effects and a hefty price tag may limit its use. P T. 2012; 37(9): 503–530.
  5. Geredeli C, Boruban MC, Poyraz N, et al. Biatrial Cardiac Metastases in a Patient with Uterine Cervix Malignant Melanoma. Case Rep Cardiol. 2015; 2015: 958756.
  6. Lee EY, Choi JO, Park HaNa, et al. Malignant melanoma of unknown primary origin presenting as cardiac metastasis. Korean Circ J. 2012; 42(4): 278–280.
  7. Onan B, Onan IS, Polat B. Surgical resection of solitary metastasis of malignant melanoma to the right atrium. Tex Heart Inst J. 2010; 37(5): 598–601.
  8. Judge JM, Tillou JD, Slingluff CL, et al. Surgical management of the patient with metastatic melanoma to the heart. J Card Surg. 2013; 28(2): 124–128.
  9. Villa A, Eshja E, Dallavalle S, et al. Cardiac metastases of melanoma as first manifestation of the disease. J Radiol Case Rep. 2014; 8(4): 8–15.
  10. Chiles C, Woodard PK, Gutierrez FR, et al. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 2001; 21(2): 439–449.
  11. Geara FB, Ang KK. Radiation therapy for malignant melanoma. Surg Clin North Am. 1996; 76(6): 1383–1398.
  12. Cates CU, Virmani R, Vaughn WK, et al. Electrocardiographic markers of cardiac metastasis. Am Heart J. 1986; 112(6): 1297–1303.