Based on PubMed | Are heart palpitations a symptom of melanoma, or could they be related to melanoma treatments, and when should someone with melanoma seek medical evaluation for them?

Heart palpitations are not a typical symptom of melanoma itself, but they can occur for other reasons in people with melanoma, including treatment‑related heart effects or, rarely, heart involvement by metastatic disease. Palpitations feel like a racing, fluttering, or pounding heartbeat and may be benign, but in the oncology setting they deserve careful attention because some melanoma therapies can affect the heart’s rhythm or function. ^[1] Modern anticancer treatments including targeted BRAF/MEK inhibitors and immune checkpoint inhibitors used in melanoma can cause heart problems such as abnormal heartbeats (arrhythmias), shortness of breath, chest discomfort, ankle swelling, or reduced heart pumping function. ^{[2] [3] [4]} These effects may appear during treatment or even months to years later, so new palpitations should be discussed promptly with a clinician. ^{[5] [6]}

How melanoma treatments can cause palpitations

• Targeted therapy (BRAF/MEK inhibitors): Regimens like encorafenib with binimetinib and vemurafenib with cobimetinib list heart problems that can include an abnormal heartbeat along with chest pain, shortness of breath, and ankle swelling. ^[2] These heart issues can occur late weeks to months after starting therapy and may continue to emerge months to years later. ^[5] Similar warnings are noted for vemurafenib alone. ^[6] The guidance commonly includes baseline and on‑treatment heart function checks. ^[3]

  • Practical takeaway: A new rapid or irregular heartbeat during or after targeted therapy may represent a treatment side effect and deserves evaluation. ^{[2] [5]}

• Immune checkpoint inhibitors (e.g., nivolumab, ipilimumab): While less common, immune‑related heart problems from these drugs can be serious, sometimes presenting with chest pain, shortness of breath, swelling, or an abnormal heartbeat within the first few months of treatment. ^{[4] [7]} Immune therapies can also disrupt thyroid function; an overactive thyroid (hyperthyroidism) can trigger a faster‑than‑usual heartbeat and palpitations. ^[8]

  • Practical takeaway: Palpitations during immunotherapy could reflect myocarditis (inflammation of heart muscle), arrhythmia, or hyperthyroidism, and should be promptly assessed. ^{[4] [8]}

Could melanoma itself cause palpitations?

Melanoma can metastasize to the heart, although this is uncommon and often not diagnosed before death; when it does involve the heart, arrhythmias like ventricular tachycardia can occur and present as fainting or severe palpitations. ^[9] Case reports describe ventricular tachycardia due to cardiac melanoma metastases, highlighting that heart rhythm problems can be a manifestation of cardiac involvement in advanced melanoma. ^{[10] [11]} In practice, this is rare compared with treatment‑related causes, but it remains a consideration if palpitations are severe, persistent, or accompanied by other warning signs. ^[9]

When to seek medical evaluation

• Urgent symptoms call emergency services or go to the ER: Palpitations with chest pain lasting more than a few minutes, shortness of breath, dizziness, lightheadedness, or fainting should be treated as urgent. ^[1] This is especially important during melanoma therapy because some drug‑related heart problems can be serious. ^{[4] [2]}

• Prompt, non‑urgent evaluation (contact your oncology team): Any new or worsening palpitations during or after melanoma treatments should be reported to your care team, even if brief, since heart issues can occur weeks to months after starting therapy and sometimes later. ^{[5] [6]} Your clinicians may check an electrocardiogram (ECG), blood tests (including thyroid function if on immunotherapy), and heart imaging to assess rhythm and pumping function. ^{[3] [12]}

• Baseline and monitoring: Many melanoma regimens recommend heart assessments before and/or during treatment, and ongoing monitoring may be advised given the potential for delayed cardiotoxicity. ^{[3] [5]} Collaborative cardio‑oncology care is increasingly used to prevent, detect, and manage therapy‑related heart issues. ^{[12] [13]}

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Quick comparison: treatment‑related heart risks

Therapy type	Examples	Heart‑related issues noted	Typical timing
Targeted BRAF/MEK inhibitors	Encorafenib + binimetinib; Vemurafenib ± cobimetinib	Abnormal heartbeat, chest pain/tightness, shortness of breath, ankle swelling; testing of heart function may be recommended	Weeks to months after starting; can occur months to years later
Immune checkpoint inhibitors	Nivolumab; Ipilimumab + Nivolumab	Uncommon but potentially serious heart problems (arrhythmias, myocarditis) within first few months; thyroid dysfunction may cause fast heartbeat	Usually within first 3 months; thyroid effects can vary

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What will evaluation involve and why it matters

A careful history and exam, ECG, blood tests (including thyroid function while on immunotherapy), and possibly echocardiography or other imaging can identify arrhythmias, myocarditis, or reduced heart function early. ^[3] In oncology, clinicians tailor management because certain cancer drugs can interact with heart medications, and cardiotoxicity can arise during or long after therapy. ^[14] Early recognition allows timely adjustments to cancer treatment and initiation of heart‑protective strategies when appropriate. ^[15] Coordinated care between oncology and cardiology teams helps balance effective cancer therapy with heart safety. ^{[12] [13]}

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Practical takeaways

• Palpitations are more often related to melanoma treatments than to melanoma itself, though rare cardiac metastases can cause arrhythmias. ^{[2] [4] [9]}
• Do not ignore palpitations during melanoma therapy tell your oncology team, especially if they are new, persistent, or accompanied by chest pain, shortness of breath, dizziness, or fainting. ^{[1] [4]}
• Expect heart monitoring before and during certain melanoma treatments, and sometimes after finishing therapy, since some heart effects can be delayed. ^{[3] [5] [12]}

Would you like help preparing a short checklist of your current melanoma medications and recent symptoms to discuss with your care team?