Disorders of the Pleura: Student/Resident Case Report Poster - Disorders of the Pleura |

Isolated Pleural Metastasis: A Rare Form of Malignant Melanoma; A Case Study FREE TO VIEW

Mario Benitez-Lopez; Livier Silva Perez; Ruth Wintz, MD
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Universidad Autonoma de Baja California, Tijuana, Mexico

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

Chest. 2016;150(4_S):595A. doi:10.1016/j.chest.2016.08.684
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SESSION TITLE: Student/Resident Case Report Poster - Disorders of the Pleura

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Melanoma is the 6th most common cause of cancer in the United States. Despite excellent rates of survival in five years, metastatic disease lowers survival rate to less than 20%1. Although lung metastasis is common, isolated pleural metastasis and pleural effusion are rare findings in malignant melanoma2.

CASE PRESENTATION: A fifty-year-old man presents from his primary care physician with a large right-sided pleural effusion on a chest x-ray and a one-month history of intermittent chest pain, dyspnea and significant weight loss. Three years ago he was diagnosed with cutaneous melanoma located on the sole of his right foot that required surgical intervention. Afterwards, the site of his previous melanoma began to darken again, but this patient did not have regular check-ups for follow-up with his oncologist. An abnormal chest x-ray (fig. 1) and a chest CT with suspicious focal oval-shaped hypodensities in the right lower lobe of the lung raised concern for malignancy. Ultrasound guided thoracentesis produced thin dark pleural fluid with abundant mesothelial cells, compatible with a malignant pleural effusion. He underwent a right sided thoracoscopic pleurodesis with biopsy (fig 2). Biopsy results confirmed metastatic melanoma, and patient was scheduled for an outpatient oncological follow-up.

DISCUSSION: Although melanoma confers a five-year survival rate of over 90%, patients with metastatic disease see their survival rates fall as low as 16.6%1. It is key for any cancer patient to receive adequate follow-up after initial treatment. In this case our patient did not have a regular medical follow up, causing delay in diagnosis of recurrence. Proper patient education is vital in aiding proper disease surveillance. Although metastasis to lung is found clinically in 18% - 36% of patients with metastatic melanoma, pleural melanoma is much rarer, with fewer than ten cases of primary pleural melanoma described since it was first reported in 19782. Very few cases of pleural metastatic melanoma have been reported, and are mostly limited to case reports. Pleural effusions are a very uncommon presentation of thoracic metastatic melanoma, seen only in 2% of those patients. The exudate can often be dark in color, due to the presence of melanin pigment in the fluid3.

CONCLUSIONS: Malignant pleural effusion is a rare presentation of metastatic melanoma. We believe, however, that close patient follow-up of melanoma survivors can facilitate early detection and treatment of recurrence in this often deadly disease.

Reference #1: SEER Cancer Statistics Factsheets: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.html.

Reference #2: Christopher T. Erb, Kelsey M. Johnson, Anthony W. Kim, MDc. Rare Pleural Tumors. Clin Chest Med 2013; 34: 113-136

Reference #3: Saraya T, Light RW, Takizawa H, Goto H. Black Pleural Effusion. Am J Med 2013 126(7): 641.e1-6

DISCLOSURE: The following authors have nothing to disclose: Mario Benitez-Lopez, Livier Silva Perez, Ruth Wintz

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