title: Endobronchial metastasis from primary anorectal melanoma.
abstract: METHODS
  Male, 64 FINAL DIAGNOSIS: Metastatic anorectal melanoma with endotracheal metastasis Symptoms: Fatigue • weight loss • hematochezia • cough
  
  
  METHODS
  None Clinical Procedure: Biopsy of anal mass • rigid bronchoscopy Specialty: Internal medicine • oncology • pulmonology.
  
  
  OBJECTIVE
  Rare disease.
  
  
  BACKGROUND
  Anorectal melanoma is a rare cancer with a poor prognosis. The mean survival after diagnosis is 15-25 months. At the time of diagnosis, 61% of patients have local regional lymph node metastases, and 21% have distant metastases. The lungs are a common site for metastasis for all tumors including melanoma. However endobronchial metastasis is a rare phenomenon. Endotracheal metastases are even rarer, occurring in only 5% of patients with extrapulmonary endobronchial metastases. It is most commonly seen in breast, colorectal, and kidney cancers. It is extremely rare for cutaneous melanoma. The mean survival after diagnosis is only 15 months and treatment options are limited.
  
  
  METHODS
  We report the case of a 64 year-old gentleman with newly diagnosed metastatic anorectal melanoma. A 3 cm by 3 cm bluish-black, oval-shaped, exophytic mass protruding from his anus was found on physical exam. Endobronchial and endotracheal metastasis to the trachea were discovered on computed tomography and he was subsequently taken to the operating room for argon plasma coagulation laser recanalization of his trachea via rigid bronchoscopy, and resection of his anal mass.
  
  
  CONCLUSIONS
  We have presented the first known case of anorectal melanoma with endobronchial metastasis. Palliative APC laser recanalization was used to prevent asphyxiation from the endotracheal mass. Endobronchial metastasis is uncommon and can be easily mistaken for primary bronchogenic carcinoma. It should always be considered when evaluating patients with new lung masses.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Heyman
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Chung
authors.forename: Amy L
authors.initials: AL
authors.lastname: Lark
authors.forename: Scott
authors.initials: S
authors.lastname: Shofer
keywords: anorectal; bronchoscopy; endobronchial; melanoma; metastasis; treatment