# Metastatic tracheal melanoma misdiagnosed as chronic obstructive pulmonary disease: A case report

## TL;DR

A rare case of tracheal melanoma was initially misdiagnosed as COPD, highlighting the importance of advanced imaging and bronchoscopy for accurate diagnosis.

## Contribution

This is the longest reported interval between cutaneous melanoma and tracheal metastasis, emphasizing the need for vigilance in long-term follow-up.

## Key findings

- Tracheal melanoma can mimic COPD, leading to delayed diagnosis due to similar spirometry patterns.
- Advanced imaging and bronchoscopy are essential for identifying rare airway lesions in atypical COPD presentations.
- Treatment with debulking, radiation, and targeted therapy led to symptom resolution and normalized spirometry.

## Abstract

Metastatic tracheal melanoma is rare, with fewer than 20 reported cases. This case describes a 62-year-old female with a history of cutaneous melanoma excised 10 years prior, initially misdiagnosed with severe COPD. We highlight the diagnostic challenges when rare metastases mimic common conditions.

Diagnosed with COPD based on dyspnoea and spirometry, the patient later developed worsening symptoms, including haemoptysis, requiring hospitalisation. A chest radiograph was unremarkable, but CT pulmonary angiogram revealed a 1.6 × 1.3 cm tracheal mass. Bronchoscopy confirmed 80–90 % luminal stenosis due to a friable mass, which biopsy identified as tracheal melanoma (BRAF V600E positive). She underwent tumor debulking via rigid bronchoscopy, followed by radiation therapy and vemurafenib.

This case represents the longest interval between cutaneous melanoma and tracheal metastasis. Spirometry showed a COPD-like scooping pattern rather than the expected large airway obstruction, delaying diagnosis. New-onset severe airflow obstruction in patients with minimal smoking history should prompt alternative considerations. Advanced imaging and bronchoscopy are essential for early detection. Treatment includes surgical debulking, radiation, and targeted therapy, with follow-up showing symptom resolution and normalised spirometry.

Metastatic tracheal melanoma can mimic COPD, leading to misdiagnosis. The prolonged latency highlights the need for vigilance in melanoma follow-up. Rare airway lesions should be considered in atypical COPD presentations, reinforcing the importance of advanced diagnostic tools for timely identification and treatment.

•Unusual Metastatic Interval: Tracheal melanoma diagnosed 10 years after primary cutaneous melanoma—the longest reported interval to tracheal metastasis.•COPD Misdiagnosis: Spirometry mimicked small airway obstruction, masking the presence of a central airway tumour.•Importance of Advanced Imaging and Direct Visualization: CT and bronchoscopy should be considered in atypical or treatment-resistant obstructive lung disease.•Figures.

Unusual Metastatic Interval: Tracheal melanoma diagnosed 10 years after primary cutaneous melanoma—the longest reported interval to tracheal metastasis.

COPD Misdiagnosis: Spirometry mimicked small airway obstruction, masking the presence of a central airway tumour.

Importance of Advanced Imaging and Direct Visualization: CT and bronchoscopy should be considered in atypical or treatment-resistant obstructive lung disease.

Figures.