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Primary melanocarcinoma of the lower respiratory tract.

A 70-year-old woman presented in May 1978 with a 12-month history of increasing exertional dyspnoea, a non-productive cough for three months but no history of haemoptysis, loss of weight, or dysphagia. She had smoked 10 cigarettes daily until 1958. There was no previous medical history of note but her daughter had died aged 31 years from disseminated melanocarcinoma after removal of a cutaneous primary from the calf. The patient's general condition was good, with minimal stridor but no finger clubbing or lymphadenopathy; reduced percussion note and breath sounds with associated wheezes were noted over the right midzone anteriorly. Chest radiography showed a dense mass in the right middle lobe, enlargement of the right hilum, and an abnormal paratracheal shadow. Numbers of darkly pigmented cells were seen on sputum cytology. Fibreoptic bronchoscopy revealed extensive black discolouration and swelling of the mucosa at the carina spreading down both main bronchi, the lumen being almost totally occluded on the right side. A biopsy showed diffuse infiltration of the bronchial mucosa by melanocarcinoma. No alternative primary was found on clinical examination and there was no history of spontaneous regression or surgical removal of a pigmented lesion. A divided four week course of radiotherapy was given with considerable symptomatic relief, but no improvement in either the radiological or bronchoscopic appearances. She died nine weeks after presentation having developed mediastinal emphysema and bronchopneumonia.