The Current Role of Surgery in the Treatment of Cardiac Metastases from Malignant Melanoma: an Educational Presentation

Abstract

A 71 year-old male with a history of multiple excisions of an initial Clark's level V melanoma of the breast followed by combined radiation and interferon treatment, as well as a recurrence, 3 years later, of a BRAF-positive tumor of the shoulder, with subsequent therapy with dabrafenib and trametinib, presented again with progressive intracardiac masses causing significant right ventricular outflow obstruction. Additionally, the patient complained of dyspnea and fatigue on exertion, thus he was scheduled for surgical resection.

Keywords: Dyspnea; Fatigue; Melanoma; Shoulder; Skin Neoplasms Recurrence, Local; Ventricular Outflow Obstruction.

Fig. 1

Radiological findings. (A, B) Contrast-enhanced axial computed tomography images through the heart showing tumor masses (red arrows) at the apex and anterior right ventricular wall of a measured diameter of 2.1-3.6 cm. (C) Magnetic resonance image obtained in long-axis projection through the right ventricle. The red arrow shows the mass filling the right ventricular cavity.

Fig. 2

Surgical resection of cardiac metastatic melanoma (view from the patient's head). (A) Standard setting with aortic and bicaval cannulation, antegrade cardioplegia. Red arrow pointing at the right ventricular tumor mass. (B) Black tumor nodules in the endocardium (red arrows). (C) Macroscopic view of the tumorous mass excised from the right ventricle with an approximate size of 7 mm (red arrow). (D) Stabilization of the tricuspid valve with a fixation stitch (blue arrows). (E) Reconstruction of the resulting ventricular wall defect with bovine pericardial patch (green star), blue arrow pointing at the fixation stitch. (F) Final result after reconstruction and decannulation.