Abstract
The role of urgent BRAF testing and therapy in cardiac melanoma presenting with cardiovascular compromise.
Highlights
Metastatic melanoma (MM) rarely presents as a cardiovascular medical emergency, the heart is a relatively common site for melanoma to metastasise to in patients with disseminated disease post-mortem [1,2]
The haematology team had discussed the risks of commencing therapy with steroids when it was thought to be lymphoma due to the extensive cardiac involvement; intra-cardiac ultrasound had confirmed that tumour was present both inside and outside the superior vena cava (SVC) and going through the wall of the right atrium
Urgent BRAF status is imperative in patients presenting with urgent life-threatening MM
Summary
Metastatic melanoma (MM) rarely presents as a cardiovascular medical emergency, the heart is a relatively common site for melanoma to metastasise to in patients with disseminated disease post-mortem [1,2]. The scan demonstrated extensive compressive mediastinal lymphadenopathy with complete effacement of the superior vena cava (SVC) and invading into the right atrium with pericardial effusion and bilateral pleural effusions, giving a possible diagnosis of lymphoma or less likely primary cardiac sarcoma. This was confirmed on subsequent Positron emission tomography (PET) scan 10 days later (figures 1a-c). Figure 1a: Contrast-enhanced CT thorax showing superior mediastinal mass compressing SVC (black arrowhead).
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