Disorders of the Pleura: Fellow Case Report Slide: Disorders of the Pleura |

Pleural Malignant Melanoma Associated With a Hairy Nevus FREE TO VIEW

Anupam Gupta, MD; Elizabeth Awerbuch, DO
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Elmhurst Hospital Center, Elmhurst, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):576A. doi:10.1016/j.chest.2016.08.665
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SESSION TITLE: Fellow Case Report Slide: Disorders of the Pleura

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: Melanomas can be primary or metastatic. Most common primary sites other than cutaneous are ocular, mucosal and urethral. We present a case of a primary pleural malignant melanoma (PMM) in a man with a hairy nevus.

CASE PRESENTATION: 46-year-old Ecuadorian male with history of congenital hairy nevus presents two-week history of worsening dyspnea. Examination notes 27 breaths/minute, oxygen saturation 96%, absent breath sounds on right lung field, and giant hairy nevus on back. Complete blood count and chemistry unremarkable. Chest CT showed multiple enhancing right pleural nodules and right pleural effusion. Thoracentesis revealed lymphocyte-predominate exudative fluid. Atypical cells noted on cytology and IHC staining unrevealing. VATS found pleural surface with innumerable grape-like lesions. Pleural biopsy revealed amelanotic malignant melanoma, positive Mel-A, S-100, Mart-1, partially positive HMB-45, and negative cytokeratin AE1/AE3. The patient refused further treatment and returned back to his country for non-allopathic treatment.

DISCUSSION: Melanomas are fifth most common type of cancer in US, 70% of cases are malignant. Lung metastasis, parenchymal or pleural, occur in about 50% of malignant melanoma. PMM is exceptionally rare. It is paramount to distinguish primary vs metastatic. Diagnostic criteria of primary lung melanoma: no previously removed pigmented skin tumors, no ocular and solitary lung tumor, primary tumor morphology compatible, no melanomas in other organs, and optional autopsy. Pathogenesis is not clearly elucidated. Suggested hypotheses include melanocytes migrating during embryogenesis, cutaneous nevus cells entering dermal lymphatic vessels, or pluripotent stem cells as precursors to melanocytes. Conventional treatment for melanoma is surgery, while chemotherapy, molecularly-targeted and immunotherapy are treatment options for advanced melanoma.

CONCLUSIONS: This is the third reported case of unusual presentation of PMM associated with hairy nevus, which adds to literature that sizeable congenital skin nevi may be risk factor for PMM. The paucity of literature and cases regarding PMM highlights importance of further investigation in diagnosis, management & treatment.

Reference #1: Mohanty, P. P., et al. (2004). “Malignant melanoma of pleura in a patient with giant congenital “bathing suit” hairy nevus.” Int J Clin Oncol9(5): 410-412.

Reference #2: Wang, Q., et al. (2015). “Primary malignant melanoma of the pleura with rapid progression: A case report and literature review.” Oncol Lett9(6): 2713-2715.

DISCLOSURE: The following authors have nothing to disclose: Anupam Gupta, Elizabeth Awerbuch

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