Skip Navigation LinksHome > June 2010 - Volume 5 - Issue 6 > Pleural Metastases of Malignant Melanoma
Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181d8738b
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Pleural Metastases of Malignant Melanoma

Nishiyama, Akihiro MD; Yoshioka, Hiroshige MD; Ishida, Tadashi MD, PhD

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Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan.

Disclosure: The authors declare no conflicts of interest.

Address for correspondence: Hiroshige Yoshioka, MD, Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan. E-mail: hirotin@kchnet.or.jp

A 58-year-old woman presented to the dermatologist with a black macula in her parietal scalp region and was diagnosed with malignant melanoma. The patient subsequently underwent resection of the tumor and received postoperative chemotherapy. Six months later, she felt general malaise and dorsal pain. 18F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a left pleural effusion, disseminated nodules in the pleura, and a high accumulation of 18F-fluorodeoxyglucose in the nodules. Diagnostic thoracoscopy revealed scattered, black spots on the pleura (Figure 1). Histopathological findings of the nodules obtained by biopsy showed malignant cells with melanin-filled cytoplasm, indicative of malignant melanoma. The patient had thoracic cavity drainage and pleurodesis and was subsequently referred to a dermatologist for systemic chemotherapy.

Figure 1
Figure 1
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The mainstay treatment for malignant melanoma is surgical excision. Even if complete surgical excision is achieved, approximately 30% of patients with malignant melanoma have distant metastases to various organs.1 The thorax is a common initial site for metastasis.2 Chen et al.3 reported that among 130 melanoma patients with thoracic metastases, 20 had pleural effusions and 3 were isolated and unilateral; it is not clear that metastatic involvement was confirmed with cytology. Our case had pleural involvement diagnosed by thoracoscopy showing distinctive black spots on the pleura.

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REFERENCES

1. Shumate CR, Urist MM, Maddox WA. Melanoma recurrence surveillance. Patient or physician based? Ann Surg 1995;5:566–571.

2. Gromet MA, Ominsky SH, Epstein WL, et al. The thorax as the initial site for systemic relapse in malignant melanoma. Cancer 1979;44:776–784.

3. Chen JTT, Dahmash NS, Ravin CE, et al. Metastatic melanoma to the thorax: report of 130 patients. Am J Roentgenol 1981;137:293– 298.

© 2010International Association for the Study of Lung Cancer

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