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Timely and Accurate Diagnosis of Rare Metastatic Melanoma With Pulmonary Vascular, Cardiac, and Brain Involvement: Improving Diagnostic Access and Minimising Risk

Year: 2025

Type: article

Abstract: We present a patient in his 40s with a history of melanoma excised 14 years prior, who developed persistent cough, haemoptysis, and chest pain. Imaging revealed a right hilar mass extending into the pulmonary artery and left atrium. PET-CT confirmed high 18F-fluorodeoxyglucose (FDG) uptake consistent with active tumour, while brain MRI showed metastatic lesions and cardiac MRI revealed intracardiac extension. An initial CT-guided lung biopsy was non-diagnostic. Due to diagnostic uncertainty, full anticoagulation (given the difficulty in distinguishing tumour from thromboembolism), and high procedural risk, endobronchial ultrasound (EBUS) was performed under conscious sedation. EBUS successfully provided a tissue diagnosis of BRAF-positive metastatic melanoma. The patient was initiated on ipilimumab and nivolumab immunotherapy, which was well tolerated with a favourable response. This case illustrates the critical role of PET-CT in distinguishing tumour thrombus from embolic disease and demonstrates the value of EBUS as a minimally invasive, safe, and effective diagnostic tool in high-risk settings. It also highlights how perseverance in diagnostic efforts can facilitate early treatment, even in complex and high-risk scenarios.

Source: Cureus

DOI: 10.7759/cureus.92784

Authors: Zaw Aung, Chaw Lwin Hsu, Rajini Sudhir, Sanjay Agrawal

Institutions: Royal Papworth Hospital, Papworth Hospital NHS Foundation Trust, West Hertfordshire Hospitals NHS Trust, Glenfield Hospital, University Hospitals of Leicester NHS Trust

Language: English

Topic: Cutaneous Melanoma Detection and Management

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4414375788