# Multimodality Imaging in Cardiac Metastasis of Cutaneous Melanoma: Case Report and Systematic Review

## TL;DR

This paper reports a case of melanoma spreading to the heart and reviews 27 cases to highlight the challenges in diagnosing and managing cardiac metastases from melanoma.

## Contribution

The study provides a systematic review and case report emphasizing the role of multimodal imaging in diagnosing cardiac metastases from melanoma.

## Key findings

- Multimodal imaging, including echocardiography and CMR, is critical for diagnosing cardiac metastases in melanoma.
- Cardiac metastases from melanoma often affect the left ventricular free wall and interventricular septum.
- Early detection and accurate diagnosis are needed to improve outcomes in patients with cardiac metastases from melanoma.

## Abstract

Background: Cardiac metastases from cutaneous melanoma are uncommon and often underdiagnosed due to their variable and frequently asymptomatic presentation. To better describe their clinical features, diagnostic strategies, and outcomes, we performed a systematic review of published case reports and present an illustrative clinical case. Case presentation: We report the case of a 67-year-old man with a history of stage IIA cutaneous melanoma who presented with progressive fatigue and dyspnea. Disease recurrence was confirmed by skin biopsy. Multimodal imaging, including echocardiography, FDG PET-CT, and cardiac magnetic resonance (CMR), demonstrated extensive myocardial infiltration consistent with cardiac metastases. Despite treatment with immunotherapy, the patient experienced progressive clinical deterioration and died six months after diagnosis. Discussion: The systematic review encompassed 23 published articles reporting 27 individual cases, with a mean age at diagnosis of 55.9 years and a clear male predominance. Cardiac involvement exhibited marked heterogeneity in both clinical presentation and anatomical distribution, most frequently affecting the left ventricular free wall and the interventricular septum. Echocardiography consistently served as the initial diagnostic modality, while cardiac magnetic resonance and CT/FDG PET-CT were used to refine lesion characterization and assess extracardiac disease. Notably, a complete multimodal imaging strategy was reported in fewer than one-third of cases, reflecting variability in diagnostic approaches. Survival outcomes were highly heterogeneous, with substantial mortality, underscoring the need for earlier detection and more accurate diagnostic strategies for cardiac involvement in melanoma. Conclusions: Cardiac metastases from melanoma represent advanced disease and remain associated with poor and heterogeneous outcomes. An integrated multimodal imaging approach supports detailed diagnostic characterization and may aid clinical evaluation and management in selected cases.