TY - JOUR
AR - SCR-2020-6-123
TI - Disseminated Pleural Malignant Melanoma
AU - Jan, Bronnert
AU - Matthias , Grade
AU - Michael , Respondek
JO - Surgical Case Reports
PY - 2020
DA - Tue 30, Jun 2020
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2020.06.23
UR - https://www.sciencerepository.org/disseminated-pleural-malignant-melanoma_SCR-2020-6-123 
KW - malignant melanoma, pleural melanoma, metastasis, disseminated pleural melanoma, BRAF V600
AB - A 68-year-old man was admitted to our hospital with a dyspnea. On physical examination the patient was not distressed. Chest X-ray demonstrated an extensive left pleural effusion (A). Pleural aspiration showed an exsudate with elevated LDH of 464 U/L (0-100 U/l). The diagnostic thoracoscopy revealed disseminated black nodules on the visceral and parietal pleura (B) and a pleurodesis was performed after obtaining multiple biopsies. The melanoma cells showed a strong cytoplasmatic HMB-45 reaction (C). Immunohistochemical staining revealed a malignant melanoma with expression of PD-L1 in 3% of the tumor cells, the moleculargenetic examination proofed a BRAF V600 mutation. The patient was treated with the kinase inhibitor Trametinib and the tyrosinkinase inhibitor Tafiniar. He had initially a good response but died 10 months later after presenting to our clinic. 3 years prior the patient had a removal of a malign melanoma on the right upper thorax wall and the surgical exploration showed micrometastases in the sentinel lymphnode of the right axilla. (SSM Clark Level IV). At that time a immunotherapy with interferon alpha 2a was initiated.