Surgical Management of the Patient with Metastatic Melanoma to the Heart

Judge, Joshua M.; Tillou, John; Slingluff, Craig L.; Kern, John A.; Krön, Irving L.; Weiss, Geoffrey R.

doi:10.1111/jocs.12054

Cited by 7 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For many tumors, echocardiography can provide information on the location, size, and mobility of cardiac masses [ 26 , 27 ]. Nevertheless, transesophageal echocardiography (TEE) is preferred to TTE, principally when a cardiosurgical procedure is planned [ 28 ]. Further imaging, including CT and MRI, may also provide useful information, and PET reassures high specificity and sensitivity, allowing us to visualize metastases at a comparatively initial stage [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical Cardiac Location of Melanoma of Unknown Origin

et al. 2021

View full text Add to dashboard Cite

The subject was a 66-year-old woman, suffering from the chest pain evoked by physical activity. Transthoracic echocardiography (TTE) revealed an abnormal structure, 41 × 29 mm. In MSCT, a hypodensic mobile tissue lesion that was infiltrating the whole thickness of left ventricle was confirmed. PET excluded the existence of other remote lesions. After surgical tumor removal, histopathological differential diagnosis revealed melanoma, myoepithelial cancer, and MPNST “high–grade” sarcoma. A control TTE detected a tumor that was 14 × 10 mm. After immunohistochemical results, immunotherapy with pembrolizumab was used, which resulted in complete tumor resolution. Presently, surgical resection and neoadjuvant targeted immunochemotherapy remain the treatment of choice for clinical stage III/IV melanoma.

show abstract

Section: Discussionmentioning

confidence: 99%

Atypical Cardiac Location of Melanoma of Unknown Origin

et al. 2021

View full text Add to dashboard Cite

show abstract

“…While immunotherapy has changed the prognosis of metastatic melanoma and durable long-term responses can now be seen, it generally does not work immediately. Therefore, patients symptomatic from cardiac metastases may require adjunctive surgery [ 5 ]. In this case, the aggressive surgical resection played an important role in the patient's long-term survival and symptomatic relief.…”

Section: Discussionmentioning

confidence: 99%

Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis

Benson

Gordon

Nicolato

et al. 2017

Case Reports in Oncological Medicine

View full text Add to dashboard Cite

Prognosis for metastatic melanoma has improved significantly with the use of immune checkpoint inhibitors. Given improvements in survival, aggressive surgical treatment may be considered in patients with life-threatening complications from their disease that would not otherwise be considered in advanced disease. Patients with preexisting autoimmune diseases or prior immune-related adverse events from therapy are largely excluded from clinical trials. Concerns exist that immunotherapy in these patients could worsen autoimmune disease or increase the risk of developing additional immune-related adverse events on therapy. We present a case of a patient with rheumatoid arthritis that presented with obstructive heart failure secondary to melanoma that had metastasized to the right atrium. After aggressive surgical resection to stabilize him from his life-threatening heart failure, he was treated with ipilimumab, which was stopped due to an immune-related adverse event. He was then started on pembrolizumab and had a durable response to therapy. Aggressive surgical treatment should be considered in patients with a cancer that may respond to immunotherapy. Furthermore, some patients with preexisting autoimmune disease may be safely treated with checkpoint inhibition therapy, and patients with a severe immune toxicity from one class may successfully be treated with an alternate class.

show abstract

“…Reduction of such symptoms and prevention of further life-threatening complications as well as potential tumor embolization are driving factors in the decision to surgically resect cardiac metastases [ 9 ]. However, surgical intervention as treatment for cardiac metastases is considered palliative rather than curative [ 10 ]. Just as clinical symptoms rely on tumor location, location of the metastases in the heart also determines the efficacy of surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Similar reports have shown an improvement in quality of life and reduction of symptoms for at least 1 year after resection of cardiac metastases [ 6 , 12 ]. However, long-term results regarding resection of cardiac metastases have yet to be evaluated, as this requires longitudinal data that is not yet present [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, dacarbazine was the single FDA approved treatment for metastatic melanoma. In recent years, ipilimumab and vemurafenib have been successful in Phase 3 clinical trials of metastatic melanoma and have been used in practice since their FDA approval [ 10 ]. In one study, patients receiving ipilimumab alone had a median overall survival of 10.1 months (95% CI) compared to the 6.4 months (95% CI) of those treated with gp100 alone, a well-studied cancer vaccine inducing immune response [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Right Atrial Metastatic Melanoma with Unknown Primaries

Kuriakose

Melvani

Gangadharan

et al. 2015

Case Reports in Cardiology

View full text Add to dashboard Cite

A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma.

show abstract

Surgical Management of the Patient with Metastatic Melanoma to the Heart

Cited by 7 publications

References 32 publications

Atypical Cardiac Location of Melanoma of Unknown Origin

Atypical Cardiac Location of Melanoma of Unknown Origin

Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis

Right Atrial Metastatic Melanoma with Unknown Primaries

Contact Info

Product

Resources

About