Endobronchial metastasis of melanoma: a clinical case

Abstract

Background. Despite high metastatic potential, melanoma rarely metastasizes to the tracheobronchial tree, accounting for 4.5-5.3% of cases. Therefore, epidemiological, clinical, and pathological features, as well as treatment, are based on individual reports in the literature. Aim. To present a clinical case of isolated endobronchial metastasis of melanoma. Materials and methods. A 67-year-old patient underwent surgical treatment for stage IIb pT2N0M0 melanoma of the IV toe of the left foot in August 2014. Histological study showed the ulcerated epithelioid cell pigment melanoma of level III invasion according to Clark classification, and the Breslow thickness was 2 mm. No adjuvant treatment was administered. Results. During the follow-up, no signs of disease progression were found. In December 2022, the patient survived a new coronavirus infection. In February 2023, the patient reported dyspnea on exertion, dry cough, and hemoptysis. Fibrobronchoscopy in the upper lobe of the left lung in one of the subsegmental branches revealed pigmentation of the bronchial mucosa of gray and black in some spots. Based on the results of cytological examination, metastasis of pigment epithelioid cell melanoma was diagnosed. According to imaging studies, no other manifestations of melanoma progression were identified. The patient received immunotherapy with pembrolizumab for 6 months with no signs of metastasis progression. Conclusion. Isolated endobronchial metastasis of melanoma is uncommon. The latency period in the presented case was 103 months. The clinical presentation included dyspnea during physical exertion, dry cough, and episodes of hemoptysis. The main diagnostic method is fibrobronchoscopy with biopsy for morphological examination. Imaging methods are necessary to establish the spread of the tumor.