Occult Metastatic Melanoma Presenting as an Acute Coronary Syndrome

Abstract

Melanoma is a tumor that virtually involves any tissue and commonly metastasizes to the heart. It is usually not diagnosed because of the absent/nonspecific cardiac signs and symptoms. Herein, we present a case of a 41-year-old man without any cardiovascular risk factor, admitted to the emergency room with chest pain, diagnosed with a myocardial infarction. Due to the presence of a mass adjacent to the mitral valve on the cardiac ultrasound examination, causing mitral regurgitation, the patient was referred to surgery. Pathological analysis of the excised specimens diagnosed the melanoma. The chemotherapy was started and achieved a partial response. Cardiac metastases usually affect the myocardium, leaving the valves unaffected. In this case, the acute coronary syndrome was the first manifestation of the malignant melanoma. We highlight the high level of suspicion needed in these cases.

Atypical Cardiac Location of Melanoma of Unknown Origin

“…Cardiac metastases usually tend to remain silent; however, they can cause (1) mechanical complications caused by the limitation of blood flow through the cardiac chambers; (2) electrical complications due to the destruction of the cardiac conduction system by myocardial infiltrative masses; and (3) embolization of the tumor, mimicking transient ischemic attacks or an acute coronary syndrome. Mainly, it affects the right side of the heart [ 19 ], but left-side metastases involving the mitral valve have also been reported [ 20 ]. Asymptomatic massive involvement of the myocardium has been termed as “charcoal heart” [ 21 ].…”