title: Black Pleural Effusion: A Unique Presentation of Metastatic Melanoma.
abstract: Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis.
authors.affiliation: Department of Internal Medicine, Critical Care and Sleep Medicine, New York University Langone Medical Center, New York, N.Y., USA.
authors.forename: Akansha
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Medical Center, New York, N.Y., USA.
authors.forename: Vikramjit
authors.initials: V
authors.lastname: Mukherjee
authors.affiliation: Mercer University School of Medicine, Macon, Ga., USA.
authors.forename: Mudit
authors.initials: M
authors.lastname: Chowdhary
authors.affiliation: Aventura Medical Center, Aventura, Fla., USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Danckers
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Medical Center, New York, N.Y., USA.
authors.forename: David
authors.initials: D
authors.lastname: Fridman
keywords: Black pleural effusion; Melanoma; Metastasis; Thoracentesis