What Is a Metastatic Malignant Melanoma?

Cardiac metastatic malignant melanoma (cardiac metastatic malignant melanoma) was first reported in 1867 by Prudhomme. Since then, with the advancement of diagnostic technology and the enhancement of autopsy, the number of reported cases has increased. The incidence of melanoma metastasis to the heart is the fourth largest source after lung cancer, lymphoma and breast cancer. Heart involvement is often part of the extensive metastasis of melanoma.

Basic Information

Visiting department

Cardiothoracic surgery

Multiple groups

Patients with malignant melanoma

Common locations

heart

Common causes

Malignant melanoma caused by blood-borne spread

Common symptoms

Dyspnea or shortness of breath, tachycardia, systolic murmur, edema, pericardial effusion, etc., pericardial effusion when combined with pericardial metastasis

Causes of cardiac metastatic malignant melanoma

The most susceptible to heart metastasis among all malignancies is melanoma. Malignant melanoma is a highly malignant tumor that affects the skin, eyes, vulva, rectum, and anus. It often affects the heart at an advanced stage (incidence rate> 50%). Because malignant melanoma is a blood-borne spread, all cardiac chambers can be affected, but most of them invade the right heart, and they mainly invade the myocardium.

Clinical manifestations of cardiac metastatic malignant melanoma

Cardiac metastatic melanoma is not widespread and often has no clinical manifestations, even those with severe myocardial destruction have insignificant clinical manifestations. Common clinical symptoms include dyspnea or shortness of breath, tachycardia, systolic murmurs, edema, pericardial effusion, etc. Pericardial effusion is more important clinical manifestation when combined with pericardial metastasis. Cardiac metastatic melanoma may show the following lesions with associated symptoms and signs:

1. Congestive heart failure caused by tumor invading myocardium.

2. Tumor embolization into coronary vessels can cause angina pectoris or myocardial infarction.

3. The tumor invades the heart valve and can cause its deformation.

4. Tumors form intracardiac obstruction.

5. Causes arrhythmia and changes in bundle branch block.

6. Pericardial compression symptoms due to pericardial fluid or diffuse lesions in the pericardium.

Cardiac metastatic malignant melanoma

Chest radiography

Continuous chest radiographs showed that the heart shadow gradually increased.

2. CT and MRI (magnetic resonance imaging) examination

Changes in the pericardium or heart can be seen.

3. ECG

Main manifestations are tachycardia, low voltage, ectopic tachycardia, and atrioventricular block.

4. Cardiac echocardiogram

Echocardiography revealed a large amount of pericardial effusion, pericardial tamponade, and echogenic masses seen in the epicardium. If necessary, pericardial puncture drainage and puncture fluid cytology can be performed under the guidance of echocardiography. Echocardiography is currently considered the best diagnostic technique.

Diagnosis of cardiac metastatic malignant melanoma

A diagnosis can usually be made before death. When patients with clinically diagnosed cutaneous melanoma develop non-anemia, hypoalbuminemia, or cardiac insufficiency due to factors such as pulmonary metastases, transthoracic echocardiography can correctly diagnose pericardial mass and pericardial effusion and severity. The following clinical manifestations should be noticed:

1. Acute pericarditis or tamponade.

2. X-ray examination has increased heart shadow.

3. Paroxysmal tachycardia or severe AV block, even heart failure.

4. Cytological examination, finding tumor cells in the pericardial puncture solution is of important diagnostic significance.

Cardiac metastatic malignant melanoma treatment

Cardiac metastatic malignant melanoma is an advanced manifestation of tumor development. Treatment is mainly to relieve symptoms and support the whole body, such as anemia, edema, hypoproteinemia and so on. When there is pleural or pericardial effusion, puncture and drainage as soon as possible or catheter drainage should be performed to reduce the pressure on the heart and lungs. Chemotherapy and immunotherapy can also be used for those with better systemic status, but malignant melanoma is more insensitive to the former, and the latter has a certain effect on enhancing the body's immunity. Radiotherapy can be used as an experimental treatment, and can also confirm the presence or absence of cardiac metastases. Arrhythmias can sometimes be controlled with digitalis treatment.

Prognosis of cardiac metastatic malignant melanoma

The prognosis is poor, and few survive longer. Malignant melanoma metastases are not just the heart, most are multiple organ metastases. Death is often due to the complications of metastases, rather than simply due to metastatic heart tumors, such as cachexia, bleeding, and infection. Malignant melanoma has the highest rate of heart metastases, is dangerous, difficult to control, and has a short survival time, which must be taken seriously.