# Pleural Metastases From Acral Lentiginous Melanoma Diagnosed by Medical Thoracoscopy

## TL;DR

A rare case of melanoma spreading to the pleura was diagnosed using medical thoracoscopy, showing its importance in identifying unusual metastases.

## Contribution

Demonstrates the diagnostic utility of medical thoracoscopy in rare pleural melanoma metastases.

## Key findings

- Medical thoracoscopy confirmed pleural metastases from acral lentiginous melanoma.
- Pigmented pleural nodules and brownish fluid were key diagnostic features.
- Talc pleurodesis provided symptom relief in advanced disease.

## Abstract

Acral lentiginous melanoma (ALM) with pleural metastases is rare and under‐recognised. We report an 86‐year‐old woman with progressive dyspnoea and pleuritic chest pain. 18 months ago, she was diagnosed with stage IIC ALM of the right heel, and was treated with wide local excision, but she declined adjuvant therapy. Imaging demonstrated a large left pleural effusion with diffuse pleural thickening, pulmonary mass, and hepatic metastases. Brownish pleural fluid, along with thoracoscopic identification of multiple pigmented nodules, led to a histologically confirmed diagnosis. Talc pleurodesis was performed for symptom control, and best supportive care was pursued. This case highlights the diagnostic value of medical thoracoscopy in identifying pleural melanoma metastases and emphasises the need to consider melanoma recurrence when pigmented effusions are encountered.

We present a rare case of metastatic acral lentiginous melanoma involving the pleural space, in which definitive diagnosis was established by medical thoracoscopy, highlighting its value in evaluating atypical pleural metastases.