**7. References**

[1] Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77: 107.

[2] Reynen K. Cardiac myxomas. N Engl J Med 1995; 333: 1610–1617.

Malignant melanoma frequently (50-71%) metastasizes to the heart (19). It seems to have the highest rate of metastases to heart. When a patient presents with cardiac metastases of melanoma, the disease has already spread throughout the body and is rarely curable (20). Single metastasis is rare. Metastases could be found in right side or left side; however, bilateral metastasis is frequently seen (21). The way of tumor spread toward heart is mostly

Previously, histologic diagnosis of malignant melanoma was made postmortem; however, with early detection of metastases due to availability of new imaging modalities, definite antemortem diagnosis and pathologic examination is frequently possible. Tissue specimen can be obtained by echocardiography guided transvenous biopsy or by resection of mass

The symptoms are nonspecific such as chronic pericarditis, congestive heart failure, pericardial effusion, tamponade, conduction disturbances or defects, arrhythmias such as ventricular or supraventricular heart rhythm disturbances (23,24), syncope, embolism events such as transient ischemic attack and hemodynamic changes secondary to valve

Malignant melanoma has the highest rate of metastases to heart; however, due to improvement in treatment for this disease, longer survival than previous is now possible (25) and with newer imaging modalities early detection of metastases is possible and the physician should be alert of the risk of metastases. Transesophageal echocardiography has higher sensitivity than transthoracic echocardiography and cardiac magnetic resonance imaging with its ability to define the mediastinal involvement could also be used. According to tumor characteristics, its burden, location and size, palliative surgery or complete

Echocardiography both transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), is the commonly available noninvasive method for the diagnosis of cardiac masses. Tumor size, location and texture, and its extension to adjacent organs, its attachment to cardiac structures, presence or absence of pericardial effusion, interference with valve function, any obstruction and tumor mobility could be evaluated by echocardiography. In patients with poor echo window, TEE gives superior results, however, in some patients for better evaluation of cardiac tumor and its extension, other imaging modalities such as MRI is needed. Extra cardiac structures could be visualized better in TTE then TEE which is important for surgeons for choosing the most suitable plan for surgery(7).

[1] Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77: 107.

hematogenous as seen in lymphoma and leukemia.

resection or adjuvant systemic therapy is recommended.

Special thanks to doctor Hyderi for his valuable comments.

[2] Reynen K. Cardiac myxomas. N Engl J Med 1995; 333: 1610–1617.

(22).

dysfunction.

**5. Summary** 

**6. Acknowledgement** 

**7. References** 


[23] Lin TK, Stech JM, Eckert WG, Liu JJ et al. Pericardial angiosarcomata simulating

[24] Coghlan JG, Paul VE, Mitchell AG. Cardiac involvement by lymphoma. Diagnostic

[25] Samiei N, Moshkani Farahani M, Sadeghipour A, Mozaffari K, Maleki M. Intracardiac

metastasis of malignant melanoma. European Journal of Echocardiography (2008)

pericardial effusion by echography. Chest 1978; 73: 881–3.

difficulties. Eur Heart J 1989; 10:765–8

9, 393–394.
