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Helsinki University Central Hospital Helsinki, Finland
Correspondence to: Teemu Mäkitie, MD, Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4 C, PL 220, FIN-00029 HUS, Helsinki, Finland; e-mail: teemu.makitie{at}hus.fi
To the Editor:
In the August 2000 issue of CHEST, Rosario and coworkers1 presented an interesting case of cardiac metastasis from intraocular melanoma. This patient suffered from syncope attacks resulting from endocardial and left ventricular metastasis and died during cardiac surgery. We agree with the authors, in that clinically detected cardiac metastasis from uveal melanoma is very rare. In addition to their report, we are aware of only two other case reports2 3 of cardiac metastases from uveal melanoma that were symptomatic and eventually lethal. A 69-year-old man died of cardiac arrest following atrioventricular block and atrial fibrillation; at autopsy, cardiac metastases were found to involve the atrioventricular node and left and right bundle branches.2 A 74-year-old woman died after biopsy of ruptured myocardium weakened by myocardial metastasis.3
Studies based on autopsy series indicate, however, that cardiac metastasis from uveal melanoma is not uncommon. Of patients who die of disseminated uveal melanoma, 19 to 24% have macroscopic cardiac metastasis at autopsy.4 5 Patients with cardiac metastasis also have widespread metastasis in general.4 Because patients with disseminated intraocular melanoma are generally elderly and many of them have other cardiovascular diseases that may obscure symptoms of cardiac metastasis, its frequency may be clinically underestimated. Rosario and colleagues1 have very prudently alerted clinicians to the possibility of cardiac involvement in uveal melanoma.
References
University of Texas Houston Medical School Houston, TX
Correspondence to: Eddy Barasch, MD, University of Texas Houston Medical School, 6431 Fannin, PO Box 20708, Houston, TX 77225 
To the Editor:
We thank you for the interesting comments. It is also our belief that any patient with cardiovascular symptoms and disseminated intraocular melanoma (or any other metastatic tumor) should have an imaging procedure investigating the cardiac anatomy.
Regarding the other two case reports mentioned by you,1 2 at the time of submission of our manuscript (September 21, 1999), we were of course not aware of the article2 published in November 1999. Although we knew about the other case report,1 which was published in Italian in 1993 and in which intramyocardial metastases (not left ventricular pedunculated mass as in our case report) were found at autopsy in two patients with malignant melanoma, we did not know that the primary tumor location was ocular because the article abstract, as it is given in PubMed, does not mention it. We still maintain our original statement that at the time of submission of our article, this was the first case report of metastatic ocular melanoma presenting as a left ventricular pedunculated intracavitary mass intermittently obstructing the left ventricular outflow tract.
References
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