Department of Clinical Oncology, National Cancer Institute, El Bosque University, Bogotá, Colombia.
Department of Surgical Oncology, National Cancer Institute, Nueva Granada Military University, Bogotá, Colombia.
Am J Case Rep. 2021 Mar 18;22:e927757. doi: 10.12659/AJCR.927757.
BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.
肺原发性黑色素瘤是一种罕见的肿瘤，占原发性肺肿瘤的 0.01%，文献中仅报道了 40 例。黏膜黑色素瘤的生物学和临床表现与皮肤黑色素瘤不同，因此治疗方法也不同。肺原发性黑色素瘤患者的生存率远低于皮肤黑色素瘤患者，并且针对该实体尚无诊断或治疗指南。当疾病可切除时，根治性手术是首选治疗方法。目前针对皮肤黑色素瘤（例如免疫疗法和靶向疗法）的既定治疗方法对这一特定亚组的疗效尚不清楚。
我们报告了一位出现咳嗽和咯血的患者。纤维支气管镜检查显示支气管内肿块，计算机断层扫描图像提示不可切除的肿块。该患者最初被诊断为不可切除的 IIIB 期（T4N2M0）原发性肺黑色素瘤。经 Pembrolizumab 治疗后，该病变达到部分缓解，从而能够进行根治性手术，实现了完全切除且切缘阴性，并在术后获得了良好的恢复。尽管我们的医疗保健系统存在延迟，但患者在诊断后 24 个月以上仍无疾病且存活。
免疫疗法可以使黏膜黑色素瘤缩小到可切除的程度，并且这种治疗方法增加了这些患者的生存机会。
