Primary malignant melanoma of the bronchus.

A rare case of primary malignant melanoma of the bronchus is described. Before considering this diagnosis, metastasis from an occult primary must be convincingly excluded and the tumour should conform to certain guidelines. This patient presented with a solitary lung tumour for which she underwent left lower lobectomy and continues to be tumour free 54 months after surgery. Two possible mechanisms of aetiology are suggested.

Carbon dioxide laser bronchoscopy--a review of its use in the treatment of malignant tracheobronchial tumours in 142 patients.

We report our experience over an 8-yr period, 1984-1991, of the use of the carbon dioxide (CO2) laser in the treatment of otherwise inoperable malignant tracheobronchial lesions. In that period 142 patients (84 male, 58 female; median age 63 years) underwent 278 procedures. The trachea was the site of treatment in 44 patients, the carina in nine, a main bronchus in 80 and a lobar bronchus in nine. All resections were performed under general anaesthesia via a rigid bronchoscope. Symptomatic relief was obtained in 103 of the 116 patients whose main complaint was dyspnoea. Overall there was a mean improvement in forced expiratory volume in 1 s (FEV1) of 27%, in peak expiratory flow (PEF) of 22% and in forced vital capacity (FVC) of 7%. Most improvement in FEV1 and PEF was obtained by the treatment of tracheal lesions. Three patients died within 24 h of surgery and 30 day mortality was 18%. At a mean follow-up of 18.3 months the mean post-laser survival is 5 months. While the CO2 laser has limitations in the treatment of distal tumours when compared to the neodymium/yttrium aluminium garnet (Nd:YAG) laser, there was no higher incidence of complications. We have found CO2 laser bronchoscopy to be an effective palliation of inoperable malignant tumours particularly of the trachea and main bronchi.