Amelanotic melanoma metastatic to the epiglottis

Cutaneous Malignant Melanoma Metastatic to the Larynx and Trachea: A Case Report and Review of the Literature

Malignant melanoma rarely develops in mucous membranes. Statistical data show that approximately 0.6-9.3% of patients with cutaneous malignant melanoma will develop metastases in the upper aerodigestive tract mucosa, and within these metastatic sites, the least common are the laryngeal and tracheobronchial ones. This exceedingly rare clinical entity has no clear treatment recommendations; radical surgery does not seem to benefit the patient in term of life expectancy. We present the case of a 56-year-old male patient diagnosed with laryngeal and tracheobronchial melanoma metastases. Prior to admission to our clinic the patient had a personal history of malignant melanoma of the nuchal region operated on 7 years ago, malignant melanoma of the gallbladder and metastatic left axillary polyadenopathy for which he underwent surgical treatment 3 months prior. Histopathological and immunohistochemical reports established the diagnosis of laryngeal metastasis of malignant melanoma. Genetic molecular analysis was positive for B-Raf (BRAF) gene and hence Vemurafenib was administered, with a favorable outcome at the one-year follow-up. Nevertheless, there are currently no clear universally accepted guidelines for the treatment of laryngeal melanoma, mainly due to the rarity of this clinical entity. We conducted a review of similar cases reported in the literature. Interestingly, reviewing the cases reported in the literature, it appears that laryngeal metastases of a primary cutaneous melanoma are more common in men, with an average time to metastasis of 4.3 years.

Laryngeal Metastatic Lesions: A Literature Review

BACKGROUND

Cancer ravages all aspects of a patient's life. In recent decades, there has been a substantial paradigm shift in the treatment of cancer with an emphasis on quality of life and patient comfort. Patients are treated holistically, a complex task given how multifaceted cancers are. Voice, a subtle indicator of patients' well-being is affected commonly by malignancies. One of the various ways by which voice is disturbed by non-laryngeal cancers is through metastasis to the larynx and adjacent areas. Metastasis to the larynx is rare but well-documented. If not diagnosed in a timely fashion, it can have devastating consequences on patients from life-threatening airway obstruction to progressive dysphonia that erodes their quality of life. Metastatic lesions of the larynx usually appear submucosal with intact overlying mucosa and are located most commonly in the supraglottis. Deep biopsies usually are needed for diagnosis, and management may entail endoscopic resection or other treatments.

OBJECTIVES

This paper reviews the literature to identify typical features of laryngeal metastatic lesions of the ten cancers that are among the most common worldwide, ie, skin, renal, breast, colorectal, lung, prostate, thyroid and liver. By summarizing their most prevalent locations in the larynx, type and appearance, the authors hope to aid physicians in their diagnostic process, particularly in cases in which laryngeal involvement is the first presenting sign of a malignancy.

Metastatic Cancer to the Larynx: A Case Report and Update

OBJECTIVE

The aim of this study was to describe a case of colorectal carcinoma metastatic to the larynx and provide a review of the current literature.

METHODS

A case report with chart review was performed. A review of the current literature was performed by systematically searching PubMed, OVID, CINAHL Plus, and EMBASE.

RESULTS

In 1988, a comprehensive literature review identified melanoma as the most common neoplasm to exhibit laryngeal involvement. Since that study, 41 subsequent cases have been reported, and among these, colorectal adenocarcinoma was the most frequent distant primary (24%). In 25 (58%) cases, curative surgery was attempted, but only 4 patients remained disease-free at last follow up. We report the history of a 52-year-old man who presented with rectal adenocarcinoma metastatic to his larynx 4 years after definitive treatment of the primary site.

CONCLUSIONS

In patients with a laryngeal mass and a history of colorectal cancer, or those at high risk of having an occult colorectal primary, metastatic spread to the larynx must always be considered. Although secondary laryngeal metastasis portends a poor prognosis, for the select patient, surgical intervention can provide long-term disease control.

Metastatic melanoma to the upper aerodigestive tract: a systematic review of the literature

This study is a systematic review of the literature that was performed to clarify the natural history and treatment outcomes of upper aerodigestive tract metastases from cutaneous melanoma. A search of the MEDLINE database was undertaken from 1950 to 2013 to identify relevant manuscripts for this review. Article inclusion required cases with documentation of previous cutaneous melanoma primary lesions, adequate survival data, and description of metastatic treatment. Individual patient data were extracted from source articles for analysis of survival outcomes. A systematic search revealed 34 relevant articles with 37 cases for inclusion. Metastases were identified throughout the upper aerodigestive tract with a predilection for the oropharynx, larynx, and oral cavity. Treatment outcomes were estimated with the Kaplan-Meier method, with survival of 37% and 16% at 1 and 5 years, respectively. As expected from previous reports, 73% presented with disseminated disease burden with almost universally poor prognosis despite locoregional or systemic therapy. Conversely, a group of patients with limited metastatic burden had improved treatment response with a 1-year survival of 90%, denoting a hazard ratio of 9.7332 (95% confidence interval, 4.5-21.1) for disseminated disease in comparison. Upper aerodigestive tract metastases of melanoma thus are rare clinical entities that in general present in the setting of disseminated disease and evidently necessitate a focus on palliation. In contrast, for those with a limited metastatic burden, aggressive multimodality therapy including complete metastectomy can produce a significant survival advantage.

Malignant melanoma metastatic to the larynx: treatment and functional outcome

The review considers management strategies for malignant melanoma metastatic to the larynx. This rare clinical entity lacks clear treatment recommendations because extirpative surgery can often result in severe functional debilitation in patients with limited life expectancy. Here, we report a case of melanoma metastatic to the larynx in a patient with a prior history of Hodgkin lymphoma. The patient was treated with partial laryngectomy and local radiation therapy. The rationale for treatment decisions and for surgical and radiotherapeutic techniques and the associated literature are discussed.

Primary Malignant Melanoma of the Epiglottis: A Rare Presentation

Primary malignant melanoma of the epiglottis is extremely rare. Until now, only 4 cases have been reported in the world literature. We describe a new case of epiglottic primary malignant melanoma in a 74-year-old man who presented with hoarseness and a foreign-body sensation. Clinical examination revealed the presence of a small, whitish, polypoid tumor on the laryngeal surface of the epiglottis; no other primary melanoma was detected. Wide excision of the lesion was performed, and microscopy revealed that it contained melanin-pigmented tumor cells in both the mucosa and submucosa. Immunostaining was positive for S-100 protein. The patient was treated with radiotherapy, and he remained well 1 year after the diagnosis with no evidence of recurrence.

Laryngeal prostatic cancer metastases: an underestimated route of metastases?

OBJECTIVE

Despite the high rate of metastases in advanced prostatic cancer, only 12 reports with 13 cases of laryngeal metastases in prostatic cancer have been given in the literature since the first description by Schmorl in 1908. A histopathological study was undertaken to clarify the obvious controversial clinical experience of multiple metastases in prostatic cancer but rare observations of laryngeal involvement.

STUDY DESIGN

Postmortem laryngeal examination in advanced prostatic cancer.

METHODS

Six patients with prostatic cancer and tumor spread to different organs but without clinical symptoms of laryngeal involvement were available for postmortem analysis. Gross anatomical inspection of the inner and outer surfaces of the removed larynx, horizontal slices of the larynx, and subsequent histological investigations including immunohistochemical analysis were used to search for metastases.

RESULTS

Macroscopic evaluation of the whole-larynx specimens did not lead to suspicion of laryngeal metastases. Interestingly, in all six larynx specimens of patients with metastatic prostatic cancer, laryngeal tumor infiltration was detected by macroscopic inspection of horizontal slices and proven histologically. Tumor infiltration ranged from focal micrometastases in the hematopoietic tissue of the ossified laryngeal skeleton to partial destruction of the external and/or internal osseous or cartilaginous lamina of the laryngeal skeleton.

CONCLUSIONS

The larynx is more often affected in metastatic prostatic cancer disease than is suggested by clinical experience. Because prostatic cancer metastasis starts in the hematopoietic areas of the ossified laryngeal skeleton, macroscopic evaluation of the whole larynx fails to detect metastases. Detecting laryngeal involvement requires horizontal slices and histological analysis.

Tumours metastasizing to the head and neck--a report of seven cases

Metastatic tumours involving the head and neck region are rare. Over the past 18 years, seven such cases were treated at our clinic. Of those, four were in one of the paranasal sinuses, three had arisen from a primary hepatocellular carcinoma and one from an osteogenic fibrosarcoma of the leg. In the remaining three cases, metastases to the larynx, the tonsil, and the parotid gland arose from a primary renal cell carcinoma, a thyroid carcinoma, and a breast carcinoma, respectively. In metastatic tumours, the primary site can often be identified by the histopathological features. Accordingly, when malignant head and neck tumours are suspected of being metastatic in character, it is important to search carefully for the primary site.