Report of rare case of melanoma in the bronchus

Dr Christopher Manley at Fox Chase Cancer Center, Philadelphia, PA and associates have reported a rare case of melanoma bronchus. The case has appeared in NEJM.

Melanoma is one of the fastest growing malignancies with the skin being the most common primary site and is the cause of 60% mortality of all skin cancers. It is highly aggressive with frequent distant metastases, for example to brain and bone. Metastasis to the lung can occur, and the lungs can also be the primary site as in previous reports. For melanoma skin is the most common primary site but surprisingly approximately 5%–10% of patients with its metastasis have no primary site.

As the history goes a 70-year-old woman reported to the pulmonary clinic with a 2-month history of progressive dyspnoea that had been unresponsive to bronchodilators. She gave a history of removal and excision of a melanoma from her left shoulder about three years ago. The results of lymph-node dissection at that time were negative for metastases.

Courtesy NEJM

Her physical examination was notable for an inspiratory and expiratory wheeze in the left lung. The computed tomography of the chest of the patient showed a polypoid lesion that obstructed the left main-stem bronchus. Later on, a rigid bronchoscopy revealed a mobile, pigmented mass arising from the bronchus.

The mass was débrided with an electrocautery snare and argon plasma coagulation. The biopsy and pathological examination of the mass confirmed a diagnosis of metastatic melanoma, with BRAF mutation. The patient’s wheezing and shortness of breath completely resolved after a tumour was excised. Chemotherapy of the melanoma with trametinib and dabrafenib was initiated.