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Updated: Sep 29, 2025
A 3D Organotypic Melanoma Spheroid Skin Model
Published on: May 18, 2018
Multichamber Involvement of Metastatic Cardiac Melanoma
Maria S Bonou1, Panagiotis Diamantopoulos2, Sofia Mavrogeni3
1Department of Cardiology, Laiko General Hospital, 17, Agiou Thoma Street, Goudi, 11527 Athens, Greece.
Insights
Melanoma rarely metastasizes to the heart, often presenting silently. This case highlights advanced melanoma with cardiac masses, diagnosed via imaging, leading to a poor prognosis despite treatment.
Area of Science:
- Oncology
- Cardiology
- Medical Imaging
Background:
- Melanoma, a skin cancer, can metastasize to various organs.
- Cardiac involvement in melanoma metastasis is uncommon and often clinically silent.
- Early diagnosis of cardiac melanoma is challenging due to its rarity and asymptomatic nature.
Purpose of the Study:
- To report a rare case of melanoma metastasis to the heart.
- To emphasize the role of multimodal imaging in diagnosing cardiac melanoma.
- To discuss the clinical presentation and prognosis of advanced melanoma with cardiac involvement.
Main Methods:
- Transthoracic echocardiogram (TTE) for initial cardiac assessment.
- Cardiac magnetic resonance imaging (CMR) for detailed evaluation of myocardial infiltration and masses.
- Computed tomography (CT) for assessing metastatic spread to other organs.
- Review of patient's treatment response to immunotherapy and chemotherapy.
Main Results:
- A 30-year-old male with in-situ melanoma developed tachycardia and elevated troponin.
- TTE and CMR revealed multiple cardiac masses in ventricles and right atrium, with significant obstruction in the right ventricle.
- CT showed widespread metastatic disease in liver, spleen, and brain.
- Despite immunotherapy (nivolumab/ipilimumab) and chemotherapy (dacarbazine/carboplatin), the patient's condition deteriorated, leading to death.
Conclusions:
- Cardiac melanoma metastasis signifies advanced disease with a poor prognosis.
- Multimodality imaging is crucial for the ante mortem diagnosis of cardiac melanoma.
- Timely diagnosis and management are critical, although treatment options are limited for widespread metastatic disease.
Abstract:
A 30-year-old man with a history of an in-situ melanoma of the forehead was referred for cardiac evaluation because of tachycardia and elevated levels of serum troponin. The transthoracic echocardiogram revealed multiple masses attached to the walls of both ventricles and the right atrium (RA). A large mass was occupying almost one third of the right ventricle (RV), resulting in reduction of the end-diastolic RV volume and tachycardia. A cardiac magnetic resonance imaging confirmed multifocal myocardial infiltration and intracavitary masses and excluded the presence of thrombus in any of the cardiac chambers. Diffuse metastatic involvement in the liver, the spleen, and the brain by computed tomography precluded surgical management. Being BRAF-unmutated, the patient was initially treated with a combination of nivolumab and ipilimumab. One month later, the cardiac metastases in RA and left ventricle were unchanged on echocardiogram, while the tumor in RV was enlarged occupying the majority of the chamber, resulting in further reduction of the cardiac output and tachycardia. The treatment was changed to a combination of dacarbazine and carboplatin, but the patient eventually died two months later. Heart is not a common metastatic site of melanoma and cardiac involvement is usually clinically silent making ante mortem diagnosis difficult. Multimodalidy imaging plays a pivotal role in the diagnostic work up. Cardiac melanoma metastases indicate an advance stage disease with poor prognosis.
