METASTATIC MELANOMA TO THE LUNG CURED WITH LOBECTOMY: A CASE REPORT

Abstract

SESSION TITLE: Cardiovascular Surgery Case Report PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: Cutaneous Melanoma is the malignant version of the melanocytes. It can have both hematogenous and lymphatogenous spread, sites of metastasis include liver, brain and bone. Lung is the most visceral site affected by melanoma metastasis. We herein present a case of a female patient with history of cutaneous melanoma that relapsed 14 years later as a solitary pulmonary nodule.CASE PRESENTATION: 79-year-old Caucasian female, with a history of chronic obstructive pulmonary disease and right forearm melanoma resected at age of 57 presents for follow up. Patient, back when she was diagnosed with BRAF V600 mutated-positive cutaneous melanoma, underwent wide local excision. Regular follow-ups, of her stage II melanoma did not prove any local or distant recurrences. In July 2014, while undergoing pre-operative work up for bladder polyp removal, patient was found to have a solitary pulmonary nodule that warranted further work up. For a better assessment of the lesion, full body positron emission tomography was obtained; it confirmed a pathological fludeoxyglucose uptake within a 2 x 2 x 1.7 cm left lower lobe pulmonary nodule (Figure 1 and 2). The maximum standardized uptake value recorded was 41. PET scan failed to show any other suspicious lesions. Thorough cutaneous exam did not reveal any skin pathology. Computed tomography (CT) guided needle biopsy was performed, revealing an aggressive melanotic tumor. The patient underwent wedge resection of the left lower lobe. The tumor was tested positive for the same BRAF mutation the previously resected melanoma harbored. Since resection, routine work-up was negative for recurrence, and CT scans of the chest did not demonstrate interval changes from previous studies.DISCUSSION: Melanoma is most commonly cutaneous, and early detection is crucial in preventing disease spread. Primary melanoma of the lung has been rarely described and results supposedly from the embryogenic migration of neural crest cells to the lungs; however, these lesions could have been easily mistaken for primary especially that cutaneous lesions are not always identified. Pulmonary metastasis from melanoma mostly occur peripherally and present as solid nodules. The peripheral location in the lung renders the wedge resection a possible and successful therapeutic option. Melanoma therapeutic approach has changed drastically with targeted therapy. Immunotherapy , as proven, has increased the 10-year survival rate in Stage IV melanoma to 20%. In a randomized clinically trial on melanoma patients with brain metastasis, immunotherapy was shown to be an alternative option.CONCLUSIONS: Melanoma is one of the most virulent cancers that has a wide clinical presentation and portrays a high mortality rate. Recently emerged therapy has changed disease course and was successful in an advanced stage of the illness.Reference #1: Prieto-Granada C, Howe N, McCardle T. Melanoma Pathology. Melanoma. 2016;1012:10–30.Reference #2: Stadelmann SA, Blüthgen C, Milanese G, Nguyen-Kim TDL, Maul JT, Dummer R, et al. Lung nodules in melanoma patients: Morphologic criteria to differentiate non-metastatic and metastatic lesions. Diagnostics. 2021;11(5).Reference #3: Tsaknis G, Naeem M, Singh A, Vijayakumar S. Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report. J Med Case Rep [Internet]. 2021;15(1):1–4. Available from: https://doi.org/10.1186/s13256-021-02933-zDISCLOSURES: No relevant relationships by Racha Abi MelhemNo relevant relationships by Ahmad Abou YassineNo relevant relationships by Marc AssaadNo relevant relationships by Loai DahabraNo relevant relationships by Khalil El Gharibno disclosure on file for Dany Elsayegh;No relevant relationships by Ahmad ItaniNo relevant relationships by Ali KassemNo relevant relationships by Hussein Rabah SESSION TITLE: Cardiovascular Surgery Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Cutaneous Melanoma is the malignant version of the melanocytes. It can have both hematogenous and lymphatogenous spread, sites of metastasis include liver, brain and bone. Lung is the most visceral site affected by melanoma metastasis. We herein present a case of a female patient with history of cutaneous melanoma that relapsed 14 years later as a solitary pulmonary nodule. CASE PRESENTATION: 79-year-old Caucasian female, with a history of chronic obstructive pulmonary disease and right forearm melanoma resected at age of 57 presents for follow up. Patient, back when she was diagnosed with BRAF V600 mutated-positive cutaneous melanoma, underwent wide local excision. Regular follow-ups, of her stage II melanoma did not prove any local or distant recurrences. In July 2014, while undergoing pre-operative work up for bladder polyp removal, patient was found to have a solitary pulmonary nodule that warranted further work up. For a better assessment of the lesion, full body positron emission tomography was obtained; it confirmed a pathological fludeoxyglucose uptake within a 2 x 2 x 1.7 cm left lower lobe pulmonary nodule (Figure 1 and 2). The maximum standardized uptake value recorded was 41. PET scan failed to show any other suspicious lesions. Thorough cutaneous exam did not reveal any skin pathology. Computed tomography (CT) guided needle biopsy was performed, revealing an aggressive melanotic tumor. The patient underwent wedge resection of the left lower lobe. The tumor was tested positive for the same BRAF mutation the previously resected melanoma harbored. Since resection, routine work-up was negative for recurrence, and CT scans of the chest did not demonstrate interval changes from previous studies. DISCUSSION: Melanoma is most commonly cutaneous, and early detection is crucial in preventing disease spread. Primary melanoma of the lung has been rarely described and results supposedly from the embryogenic migration of neural crest cells to the lungs; however, these lesions could have been easily mistaken for primary especially that cutaneous lesions are not always identified. Pulmonary metastasis from melanoma mostly occur peripherally and present as solid nodules. The peripheral location in the lung renders the wedge resection a possible and successful therapeutic option. Melanoma therapeutic approach has changed drastically with targeted therapy. Immunotherapy , as proven, has increased the 10-year survival rate in Stage IV melanoma to 20%. In a randomized clinically trial on melanoma patients with brain metastasis, immunotherapy was shown to be an alternative option. CONCLUSIONS: Melanoma is one of the most virulent cancers that has a wide clinical presentation and portrays a high mortality rate. Recently emerged therapy has changed disease course and was successful in an advanced stage of the illness. Reference #1: Prieto-Granada C, Howe N, McCardle T. Melanoma Pathology. Melanoma. 2016;1012:10–30. Reference #2: Stadelmann SA, Blüthgen C, Milanese G, Nguyen-Kim TDL, Maul JT, Dummer R, et al. Lung nodules in melanoma patients: Morphologic criteria to differentiate non-metastatic and metastatic lesions. Diagnostics. 2021;11(5). Reference #3: Tsaknis G, Naeem M, Singh A, Vijayakumar S. Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report. J Med Case Rep [Internet]. 2021;15(1):1–4. Available from: https://doi.org/10.1186/s13256-021-02933-z DISCLOSURES: No relevant relationships by Racha Abi Melhem No relevant relationships by Ahmad Abou Yassine No relevant relationships by Marc Assaad No relevant relationships by Loai Dahabra No relevant relationships by Khalil El Gharib no disclosure on file for Dany Elsayegh; No relevant relationships by Ahmad Itani No relevant relationships by Ali Kassem No relevant relationships by Hussein Rabah