Melanoma in the Bronchus
A 70-year-old woman was referred to the pulmonary clinic with a 2-month history of progressive shortness of breath that had been unresponsive to bronchodilators. Three years before presentation, a melanoma had been excised from her left shoulder. The results of lymph-node dissection at that time were negative for metastases. Physical examination was notable for an inspiratory and expiratory wheeze in the left lung. Computed tomography of the chest showed a polypoid lesion that obstructed the left main-stem bronchus (Panel A, arrow). Rigid bronchoscopy revealed a mobile, pigmented mass arising from the bronchus (Panel B ). The mass was débrided with an electrocautery snare and argon plasma coagulation. Pathological examination of the mass confirmed a diagnosis of metastatic melanoma, with BRAF mutation. The patient’s wheezing and shortness of breath completely resolved after the tumor was excised. Treatment of the melanoma with trametinib and dabrafenib was initiated.
