Disclosures: Justin X. Tu, MD: No financial relationships or conflicts of interest
Case Description: The patient had warmth and redness at the mass site associated with worsening leg swelling. Fine needle aspiration of the mass and a PET scan demonstrated melanoma recurrence with metastases to the right leg regional lymph nodes. He was started on pembrolizumab, but later reported increased pain, pressure, and size of his leg, with difficulty straightening his leg and impaired mobility. He required some assistance from his wife for ambulation. After deep venous thrombosis was ruled out, the patient was started on dabrafenib and trametinib due lack of response to pembrolizumab. He was prescribed meloxicam and tramadol for pain relief, a compression sleeve for swelling, and a foot drop orthosis brace for decreased ankle dorsiflexion.
Setting: Outpatient hematology/oncology and cancer rehabilitation clinics.
Patient: A 57-year old male with history of right posterior thigh melanoma excised in 2004 presenting with a right calf mass. Assessment/
Results: After beginning his adjusted chemotherapy regimen, there was significant decrease in metastatic lesion size, and improved mobility close to his functional baseline. His pain was well-controlled with a night-time dose of tramadol. Subsequent PET/CT scan showed near-complete resolution of the right leg soft tissue mass and minimal residual FDG uptake.
Discussion: Compartment syndrome involves the pressure of a muscle compartment being abnormally elevated, classically developing acutely after fractures, crush injuries, and other significant trauma. Pain occurs with stretching of the involved muscles, with associated paresthesias, muscle tightness, and potentially paralysis. We report a case of compartment syndrome in the setting of metastatic melanoma. The patient’s symptoms correlated with tumor expansion in his lower extremity posterior compartment, and they improved with treatment response.
Conclusion: As far as we know, there has been one documented case of malignant melanoma causing compartment syndrome. It is important to consider compartment syndrome in a patient with symptoms consistent with the diagnosis and a history of malignancy.
Level of Evidence: Level V
To cite this abstract in AMA style:
Tu JX, Kelleher NC. Metastatic Melanoma as a Rare Cause of Distal Lower Extremity Compartment Syndrome [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/metastatic-melanoma-as-a-rare-cause-of-distal-lower-extremity-compartment-syndrome/. Accessed May 16, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/metastatic-melanoma-as-a-rare-cause-of-distal-lower-extremity-compartment-syndrome/