Tailored management of a melanoma patient with bleeding brain metastases and deep vein thrombosis with thrombectomy.
Antonella Viterbo, Filippo De Angelis, Corrado Ceccarelli et al.
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Case in brief
A 62-year-old man with disseminated melanoma developed multiple brain metastases with hemorrhagic transformation, pulmonary embolism, and deep vein thrombosis (DVT). After managing cerebral edema, he received combination immunotherapy, followed by radiotherapy and targeted therapy. He later underwent mechanical thrombectomy for symptomatic DVT, with no recurrence of DVT noted at 6-month follow-up. The patient experienced partial regression of metastases but had a recurrence of intracranial hemorrhage.
What made this case unusual
The case illustrates the successful use of mechanical thrombectomy in a patient with bleeding brain metastases and DVT, where traditional anticoagulation was contraindicated.
Diagnostic / clinical pearl
Clinicians should consider a multidisciplinary approach in managing complex cases of melanoma with bleeding brain metastases and DVT, particularly when anticoagulation is not feasible.
Why it matters
This case underscores the importance of integrating various treatment modalities to improve patient outcomes in challenging scenarios involving cancer-related complications.