Images in Clinical Medicine
Intratracheal Melanoma Metastases
N Engl J Med 2006; 355:1357September 28, 2006
- Article
A 42-year-old woman with metastatic melanoma presented with a 1-month history of dyspnea and wheezing. The diagnosis of malignant melanoma had been made 6 years earlier on the basis of a biopsy of an enlarging mole on her left foot. The melanoma was 8.5 mm in depth, Clark level V, without involvement of the regional lymph nodes (stage II disease). One year before the current presentation, liver and bone metastases were diagnosed, and therapy with temozolomide was initiated, with a good response. Treatment with this agent was ongoing at the time of the current presentation. Pulmonary-function testing showed preserved total lung capacity, proportionately reduced forced expiratory volume in 1 second (as a percentage of the predicted value) and forced vital capacity, with a lack of response to bronchodilators. The flow-volume curve was suggestive of a fixed extrathoracic airway obstruction (Panel A). Computed tomography of the neck showed an obstructing intratracheal mass (Panel B, arrow). Flexible laryngoscopy revealed a partially obstructing pigmented subglottic mass (Panel C). These lesions were resected transorally, and melanoma metastases were detected on pathological examination. The patient's pulmonary symptoms resolved after she underwent a tracheostomy and received radiation therapy. After 1 year of follow-up, she has no further airway complications and continues to receive palliative therapy for melanoma.
Aditya Bardia, M.D., M.P.H.
Ravi D. Rao, M.D.
Mayo Clinic, Rochester, MN 55905
rao.ravi@mayo. edu
