Endobronchial, laryngeal and mediastinal melanoma: a rare constellation of metastatic disease

BMJ Case Rep. 2019 May 8;12(5):e228957. doi: 10.1136/bcr-2018-228957.

Abstract

A 45-year-old man presents with acute respiratory failure. Imaging revealed a left mainstem endobronchial mass with subcarinal lymphadenopathy, but no other evidence of a primary tumour. An incidental laryngeal nodule was found during bronchoscopy. Biopsies of this lesion by nasopharyngoscopy and subcarinal lymph nodes via mediastinoscopy were performed. Histopathological and immunohistochemical examination showed evidence of melanoma in both samples. Mutational analysis identified the presence of a BRAFV600E mutation. The patient underwent bronchoscopic ablation of the left mainstem endobronchial tumour with laser therapy followed by initiation of encorafenib and binimetinib combination therapy. The patient remains alive at 4 months after initial presentation of disease. This case adds to the body of literature highlighting the clinical heterogeneity and challenges of the management of metastatic pulmonary melanoma. To the best of our knowledge, this simultaneous constellation of metastasis has not been described before.

Keywords: cancer intervention; lung cancer (oncology); respiratory medicine; skin cancer.

Publication types

  • Case Reports

MeSH terms

  • Biopsy, Needle
  • Bronchial Neoplasms / diagnostic imaging
  • Bronchial Neoplasms / secondary*
  • Bronchial Neoplasms / surgery
  • Bronchoscopy
  • DNA Mutational Analysis
  • Humans
  • Immunohistochemistry
  • Laryngeal Neoplasms / diagnostic imaging
  • Laryngeal Neoplasms / secondary*
  • Laryngeal Neoplasms / surgery
  • Laser Therapy*
  • Lymphadenopathy
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / pathology*
  • Male
  • Mediastinal Neoplasms / diagnostic imaging
  • Mediastinal Neoplasms / secondary*
  • Mediastinal Neoplasms / surgery
  • Melanoma / diagnostic imaging
  • Melanoma / pathology*
  • Melanoma / surgery
  • Middle Aged
  • Treatment Outcome