Abstract Introduction Melanoma was the fifth most common cancer in the US in 2021, preceded by breast, prostate, colorectal, and renal cancers. It accounts for only 1% of skin cancers, however, causes the majority of deaths due to skin cancer. In the United States, incidence is increasing and occur in about 1 in 30 men and 1 in 40 women. About 4-5% of cases are first discovered by diagnosis of distant metastasis. The most important factor in prognosis is the stage at which it is diagnosed. This case presents a patient who was first diagnosed due to multiple metastatic lung lesions. Case Presentation Patient is a 41-year-old female with a past medical history of hypertension presented to urgent care with one week of dyspnea on exertion and dry cough. She attributed it to noxious stimuli while camping the week prior. She was recommended to go to the emergency room but declined to attend for about a week. She was given a course of cefdinir and doxycycline. A week later, after being admitted from the ER, further work up revealed innumerable bilateral lung nodules on both chest Xray and CT. She denied other symptoms like fevers, chills, weight loss, risk factors for tuberculosis, or other environmental exposures. Fungal workup was negative. Metanephrines were normal. She was a homemaker and had less than 5 pack years smoking history. No history of drug or alcohol abuse. Family history of mother with melanoma. In the hospital, she had a bronchoscopy with transbronchial biopsies of RB2, RB3, RB7, and RB8 that were nondiagnostic. Repeat bronchoscopy about two weeks later revealed malignant melanoma present in lymph nodes 11R and 11L, left lower lobe transbronchial biopsies, and bronchial lavage. Discussion The lungs are the most common organ that melanoma metastasizes to, occurring in up to 30-40% of cases. While risk increases with age, clinical suspicion should be raised in patients with imaging showing signs of metastasis in young patients as well. This holds especially true in patients like this who have a family history of melanoma. Unfortunately, many patients are not aware of their risk of melanoma and don’t often consider the possibility when they develop lung symptoms, especially when they are initially asymptomatic. This case is important because as clinicians, it can be easy to miss melanoma as a cause of metastatic cancers, especially with metastasis to the lungs. This abstract is funded by: None
Eerhart et al. (Fri,) studied this question.