Metastatic ocular melanoma to the left ventricle inducing near-syncope attacks in an 84-year-old woman

Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes

BACKGROUND

Cardiac metastasis of melanoma is rare and typically diagnosed post-mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis.

METHODS

We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis.

RESULTS

Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2-years post-diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients.

CONCLUSIONS

Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.

Cardiac Metastases from Choroidal Melanoma

In patients with uveal melanoma, cardiac metastases can present without any symptoms. It is becoming more common than previously thought and highlights the importance of routine surveillance after definitive treatment.

Left ventricular metastasis from ocular melanoma: a new, rare, and unusual pathway?

Melanoma is a neoplasm known for its propensity for cardiac involvement. When there exists an isolated metastasis to the heart, the melanoma tends to involve the right heart. Rarely does melanoma metastasize to the left ventricle. We report the first case of choroidal melanoma that had indeed metastasized to the left ventricle and was associated with a patent foramen ovale, which may explain its initially surprising location on this side of the heart.

Metastatic melanoma causing complete atrioventricular block--the role of FDG PET/CT in diagnosis

Cardiac involvement with melanoma is not uncommon, but only a few are reported to have antemortem diagnosis. Here, we report a case of a patient with melanoma causing complete atrioventricular block, which is a rare complication of this condition. The patient had multiple metastatic lesions from melanoma and had undergone multiple surgeries and later developed asystole which was treated with a pacemaker. Echocardiogram was performed but no metastatic lesion suggested or detected. Cardiac metastasis was not suspected until 5 months later when the patient underwent a FDG PET/CT for a whole-body evaluation which was interpreted to be suspicious for metastasis to the myocardium. This was confirmed by a repeat myocardial FDG PET scan. In this case report, the role of FDG PET in melanoma patients with cardiac involvement is discussed.

Obstructive metastatic malignant melanoma of the heart: Imminent pulmonary arterial occlusion caused by right ventricular metastasis with unknown origin of the primary tumor

Whether primary or metastatic, cardiac neoplastic diseases are relatively uncommon disorders. Although any malignancy may involve the heart, malignant melanoma (MM) has a significant tendency to metastasize to the heart. Cardiac involvement may occur during the course of MM or years after surgical therapy, but rarely metastasis may be the initial manifestation of the disease. This article reports a metastatic MM case that was initially manifested by heart failure symptoms because of right ventricle outflow obstruction and for which the primary focus could not be determined.

The surgical management of metastatic melanoma

When deciding whether or not to perform a resection for metastatic melanoma, one should follow general principles that apply to the patient with melanoma as well as to the patient with metastases from other types of primary tumors. When the resection is palliative, the success of surgical treatment will be governed by the presence of identifiable symptoms, the morbidity of the procedure, the course of the disease, and the ability to communicate treatment goals among surgeon, patient, and family. When the resection is performed with curative intent, long-term survival depends on the ability of the surgeon to select patients with a pattern of recurrence suggestive of a less aggressive tumor biology. Regardless of the extent of the operative procedure, resection of metastases in patients whose disease recurs early after the treatment of the primary tumor, in those who present with multiple lesions, and in those who present with disease that cannot be completely resected will only rarely be associated with subsequent long-term survival.

Circulatory shock

Patients with malignancy may present with acute circulatory compromise requiring ICU monitoring and care. The clinician must be familiar with a multiplicity of acute and chronic medical conditions common to the general population and also with conditions directly related to cancer or therapy thereof.