Endobronchial melanoma metastasis. A rare relapse

Melanomas are skin derived malignant tumors exhibiting extreme diversity during disease progression in terms of time and site of metastasis. This is a rare case of a 68 year old, former smoker male, with a history of a cutaneous head melanoma which was treated 20 years ago. He presented with dyspnea and mild hemoptysis. On examination a solid mass found at the right lower lobe. Bronchoscopy performed and biopsies taken revealing endobronchial metastatic melanoma. Tissue genomics revealed two rare mutations. Finally patient received a doublet of immunotherapy and targeted therapy regiments. To the best of our knowledge this is a rare case of endobronchial metastasis 20 years after the treatment of the primary site. After so many years elapsed it is difficult to make a differential diagnosis between metastasis and a second primary endobronchial melanoma. Surgery and bronchoscopic modalities are promising only if they can be combined with immunotherapy and targeted therapies which are the game changers regarding the treatment of the disease.