Current diagnosis and management of cardiac melanoma: a case series and review

Malignant melanoma is believed to have the highest rate of cardiac metastasis of any cancer based on autopsy studies, but descriptions of clinical findings, diagnosis, and treatment remain lacking. In particular, the use of immunotherapy has been only sparingly described. We present eight cases of malignant melanoma treated at our institution. Four patients displayed symptoms, three were diagnosed on routine surveillance imaging, and one was diagnosed postmortem. Locations of cardiac tumors varied with all four chambers and septum involved between the cases. Six patients underwent genetic profiling: two patients had a CDKN2A variant detected in their cardiac tumor, one patient had a BRAF mutation, and one patient had an NRAS mutation. Six patients underwent immunotherapy with either anti-PD-1 and/or anti-CTLA-4 therapy. This report highlights the importance of considering cardiac melanoma in surveillance imaging and the use of immunotherapy for management.