Sudden death due to undiagnosed cardiac metastasis of malignant melanoma revealed by autopsy: a case report.

Cardiac metastases from malignant melanoma are rare and often remain undiagnosed until autopsy due to their nonspecific clinical presentation. The case report concerns a woman in her 40 s, with medical history of coeliac disease who presented with a triad of cholestatic jaundice, weight loss and generalised weakness. Acute cardiac symptoms occurred during the patient's hospitalisation, with dyspnoea and palpitations preceding refractory ventricular arrhythmias and sudden death. Post mortem examination showed extensive metastatic melanoma that included the lungs, liver, spleen, lymph nodes and notably the myocardium and the endocardium. Importantly, no cutaneous or mucosal primary site was identified, classifying this case as melanoma of unknown primary (MUP). The histological and immunohistochemical analysis confirmed the diagnosis. This case report summarises the range of diagnostic issues associated with cardiac metastasis from melanoma, where the clinical presentation can mimic other cardiac pathologies and cause undiagnosed fatal arrhythmias. The findings emphasise the significance of meticulous autopsy and histological examination in elucidating unrecognized cardiac involvement in patients with metastatic melanoma, particularly in MUP.