Allergy and Airway |

Endobronchial Malignant Melanoma Debrided by Cryotherapy FREE TO VIEW

William Parker, DO; Ramez Sunna, MD
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University of Missouri-Columbia, Columbia, MO

Chest. 2013;144(4_MeetingAbstracts):20A. doi:10.1378/chest.1703075
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SESSION TITLE: Bronchology Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Cryodebridement of malignant endobronchial lesions can be used as a palliative treatment to improve dyspnea and quality of life.

CASE PRESENTATION: A 57 year-old male was diagnosed with cutaneous melanoma of the left posterior shoulder in 2009. He underwent wide local excision and regional lymph nodes were negative for metastases. In 2010 a PET CT showed uptake in a level V lymph node of the neck that was confirmed to be malignant melanoma. Treatment consisted of radiation therapy and five cycles of Temodar. In 2012 a CT of the chest was obtained to evaluate increasing dyspnea; it identified an endobronchial lesion in the distal left mainstem bronchus. Bronchoscopy revealed a large endobronchial lesion occluding the entrance to the left upper lobe (fig 1), confirmed to be malignant melanoma on biopsy. Debridement using cryotherapy was performed to improve dyspnea and reduce the risk of post-obstructive infections(fig 2). Given the need for multiple passes with the bronchoscope, we performed the procedure under moderate to deep sedation with an artificial airway in place. This was accomplished on an outpatient basis and he was discharged on the same day with improved symptoms.

DISCUSSION: Malignant melanoma can metastasize to the lung in up to 19% of affected patients.1 The role of cryotherapy in malignant endobronchial disease is palliative. Patient selection should include those with short endobronchial lesions with patent distal airways where symptoms are at least partially attributable to the lesion of interest.2 Cryotherapy has an excellent safety profile. Collagen, cartilage and other poorly vascularized tissues that support the respiratory tree are cryo-resistant due to the low vascularity of these tissues.3 Side effects include transient fever and sloughing of material that can lead to airway obstruction.3

CONCLUSIONS: Cryotherapy is a reasonable approach for palliation in patients with metastatic endobronchial malignancies where the lesion is short and there are patent airways distal to the lesion.

Reference #1: Meyer T, Merkel S, Goehl J, Hohenberger W: Surgical Therapy for Distant Metastasis of Malignant Melanoma. Cancer 2000; 89:1983-1991.

Reference #2: Eiler B, Savy FP, Melloni B, Germouty JD. Tumoral Tracheobronchial Obstruction by Cryotherapy Using a Flexible Catheter. Presse Med, 1988; 17:2138-2139.

Reference #3: Vergnon JM, Huber RM, Moghissi K. Place of Cryotherapy, Brachytherapy, and Photodynamic Therapy in Bronchoscopy of Lung Cancers. EurRespir J 2006; 28: 200-218.

DISCLOSURE: The following authors have nothing to disclose: William Parker, Ramez Sunna

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