Oncoptysis as the primary presentation of metastatic melanoma: A case report

Malignant melanoma is an aggressive skin cancer with a strong tendency to metastasize to distant organs, including the lungs. Pulmonary metastases typically present with nonspecific respiratory symptoms such as cough and dyspnea. Oncoptysis, the expectoration of tumor tissue, has been reported in only two documented cases of melanoma, with less than 50 cases reported in the literature across all malignancies. We present the case of an 88-year-old female complaining of cough and hemoptysis upon arrival to the emergency department. Upon arrival, the patient expectorated abnormal appearing tissue, which was thought initially to be lung tissue. Chest computed tomography (CT) revealed a 8 × 7 cm mass in the right lower lobe. Pathological analysis of the mass confirmed metastatic malignant melanoma in the lungs. Given that she presented with hemoptysis and respiratory distress, antiplatelet therapy was halted to minimize bleeding while bronchodilators were initiated along with supplemental oxygen. While the hemoptysis and patient's respiratory status improved, the patient declined aggressive chemotherapy and requested hospice care at home after discussions regarding her diagnosis. This case highlights a highly unusual presentation of metastatic melanoma and adds to the sparse literature on oncoptysis. The spontaneous expectoration of tumor tissue underscores the potential for central airway involvement in pulmonary metastases. Clinically, this reinforces the importance of considering malignancy in the differential diagnosis of hemoptysis, particularly in patients with a remote history of melanoma and atypical appearing expectorated sputum. Furthermore, it contributes to our understanding of how aggressive malignant progression can manifest in rare but dramatic ways, informing both careful diagnostic evaluation and palliative management strategies.