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. 2023 Feb;12(3):2356-2367.
doi: 10.1002/cam4.5058. Epub 2022 Jul 27.

Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes

Alexander M Balinski  1 , Alexi L Vasbinder  2 , Connor C Kerndt  3 , Tonimarie C Catalan  2 , Nathan P Parry  1 , Rafey A Rehman  1 , Pennelope Blakely  2 , Raymond Y Yeow  2 , Monika J Leja  2 , Christopher D Lao  4 , Leslie A Fecher  4 , Salim S Hayek  2
Affiliations

Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes

Alexander M Balinski et al. Cancer Med. 2023 Feb.

Abstract

Background: Cardiac metastasis of melanoma is rare and typically diagnosed post-mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis.

Methods: We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis.

Results: Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2-years post-diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients.

Conclusions: Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.

Keywords: epidemiology; melanoma; metastasis; prognosis.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Patient population age distribution of patients with cardiac metastasis of melanoma comparing cohort study (black) vs systematic review (gray).
FIGURE 2
FIGURE 2
Comparison of the cohort study (black) vs systematic review (gray) patients: (A) symptoms at initial presentation, (B) physical exam findings at initial presentation, (C) cardiac metastasis of melanoma locations, and (D) cardiac metastasis of melanoma treatment strategies.
FIGURE 3
FIGURE 3
Cumulative incidence of cardiovascular complications within one year after cardiac metastasis. Abbreviations: ACS, acute coronary syndrome; AV, atrioventricular; A‐fib, atrial fibrillation; PE, pulmonary embolism; V‐fib, ventricular fibrillation; V‐tach, ventricular tachycardia; VTE, venous thromboembolism.
FIGURE 4
FIGURE 4
Kaplan–Meier survival curve stratified by cardiac metastasis.
See this image and copyright information in PMC

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