Rare Case of Metastatic Melanoma With Biventricular Cardiac Involvement: Diagnostic Challenges and Multimodal Management Strategies.

BACKGROUND: Melanoma is an aggressive skin cancer with rising global incidence and potential for widespread metastasis, including to the heart. Cardiac involvement is rare, and standardized diagnostic and management strategies remain undefined. CASE SUMMARY: We present a patient with biventricular cardiac metastases from melanoma. Multimodal imaging-including transesophageal echocardiography, cardiac magnetic resonance imaging, and positron emission tomography-computed tomography-was essential in identifying cardiac tumor burden. The patient was treated with combination checkpoint inhibitor therapy (nivolumab and ipilimumab) and underwent surgical debulking. Clinical response was favorable. DISCUSSION: This case underscores the importance of high clinical suspicion, especially as cardiac metastases may be clinically silent. It highlights the value of multimodal imaging in diagnosis, the role of systemic immunotherapy, and careful patient selection for surgery. Close monitoring during immunotherapy is vital given potential adverse effects. TAKE-HOME MESSAGES: Cardiac metastases from melanoma require a high index of suspicion and multimodal imaging for diagnosis. Multidisciplinary, individualized management is essential, especially when combining immunotherapy with surgical intervention.