Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma: A case report and literature review

Table 2 Case management of primary and metastatic tracheal melanoma in the literature

Ref.	Year	Age	Sex	Primary/metastatic	Original site	Symptoms	Obstructiona	location	Size	Management	IHC Stain	Outcome
Rosenberg et al[5]	1965	46	F	Metastatic	cheek	Hemoptysis	Grade III stenosis	Carina	3.5 cm	Partial excision	-	Died 9.5 yrs later
Mori et al[6]	1977	47	F	Primary	tracheal	Dyspnea	Grade I stenosis	Mid-trachea	1.5 cm	Resection and anastomosis	--	Alive 1 yr later
Andrews et al[7]	1981	28	M	Metastatic	shoulder	Dyspnea, hemoptysis	50% obstruction	distal trachea	---	laser	-	Died 10 days later
Castro et al[8]	1990	68	M	Metastatic	nasal	Dyspnea	90% obstruction	Carina	Large	YAG laser	-	No recurrence in 9 months
Duarte et al[9]	1998	32	F	Primary	tracheal	Exertional dyspnea	85% obstruction	6cm below vocal cord	2.3 cm × 1.3 cm	Resection and anastomosis	HMB-45(+), S100(+)	Died 13 months later
Koyi et al[10]	2000	54	M	Metastatic	shoulder	Dyspnea	50% obstruction	Carina	--	YAG laser	--	Died 4 months later
Capaccio et al[11]	2002	61	F	Metastatic	shoulder	Dyspnea	Grade III stenosis	Mid-trachea	1.5 cm × 1 cm	Tracheostomy, Argon plasma coagulation	-	Died 3 months later
Bardia et al[12]	2006	42	F	Metastatic	foot	Dyspnea	50% obstruction	Subglottic	---	Tracheostomy and radiotherapy	--	Alive 1 yr later
Terra et al[13]	2008	29	F	Primary	tracheal	Dyspnea	90% obstruction	3 cm below vocal cord	2.5 cm × 1.7 cm × 0.5 cm	Tracheostomy, resection and anastomosis	HMB-45(+), S100(+)	Survived 4 yrs after diagnosis
Cekin et al[14]	2010	22	M	Primary	tracheal	Dyspnea and hoarseness	80% obstruction	Mid-trachea	1.5 cm × 2 cm	Tracheotomy, resection and anastomosis	HMB-45(+), Melan-A(+), S100(+)	Alive 3 yrs later
Nureki et al[15]	2012	73	M	Primary	Tracheal	No symptoms	Grade I stenosis	Mid-trachea	9 mm	Resection and anastomosis		Died 2 yrs later
Shelton et al[16]	2013	58	M	Metastatic	arm	Hemoptysis	Grade I stenosis	Mid-trachea	-	laser	-	Not mentioned
Heyman et al[17]	2013	64	M	Metastatic	anorectal	Cough	75% obstruction	Distal trachea	-	Argon plasma coagulation	-	Died 9 days later
Mark et al[18]	2013	64	M	Primary	laryngotracheal	Exertional dyspnea	Grade III stenosis	Subglottic	1.3 cm × 4.9 cm	Awake tracheostomy, tumor resection	Pan melanin (+), S100(-)	Hospice care 10 months later
Imai et al[19]	2015	68	M	Primary	Tracheal	Stridor, hemoptysis	90% obstruction	Carina	2.5 cm × 2 cm × 1.5 cm	Chemotherapy, radiotherapy	HMB-45(+), Melan-A(+), S100(+)	Not mentioned
Purcell et al[20]	2015	50	F	Metastatic	Shoulder	Stridor, dyspnea	90% obstruction	Mid-trachea	-	Bronchoscopic resection	-	Alive 6 months later
Costa et al[21]	2017	85	F	Thyroid metastasis	Nasal	Dyspnea	> 50% obstruction	Mid-trachea	-	Thyroidectomy	HMB-45(+),S100(+)	Died 5 months later
Fung et al[22]	2018	73	F	Tracheal metastasis	Nasal	Dyspnea at rest	Nearly-total obstruction	Distal trachea	-	Preemptive VV-ECMO, tumor resection	--	Died 4 months later
Trugillo et al[23]	2019	47	M	Metastatic	Nasal	Dyspnea	90% obstruction	Mid-trachea	-	resection	-	Not mentioned
Siraneci et al[24]	2020	80	F	Thyroid metastasis	Unknown	Dyspnea, stridor	Grade III stenosis	1cm below vocal cord	---	Metal stent	HMB-45(-), S100(+)	Died 2 wks later
Cruz et al[25]	2020	45	M	Primary	Tracheal	Cough, hemoptysis	< 20% obstruction	Cricoid level	Small	Argon plasma coagulation	-	Immunotherapy, alive 2 yrs later
Present case	2022	41	M	Metastatic	Retromolar	Exertional dyspnea, hemoptysis, syncope	90% obstruction	carina	3 cm x 2.5 cm x 2 cm	Rescue VV-ECMO, tumor resection, tracheal stent	HMB-45(+), Melan-A(+), S100(+)	Died 1 yr later

ECMO: Extracorporeal membrane oxygenation; VV: Veno-venous; IHC stain: Immunohistochemistry stain.

^aObstruction is defined as the percentage of obstructed tracheal lumen or grade of subglottic stenosis according to the Meyer-Cotton grading scale. Grade 1 stenosis is defined as a lumen obstruction of < 50%. Grade 2 stenosis is 51%-70% of lumen obstruction. Grade 3 stenosis accounts for 71%-99% of lumen obstruction.