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Yee EJ, Thielen ON, Truong R, Gilbert D, Michel K, Couts KL, Robinson WA, McCarter MD. Metastatic Melanoma to the Small Bowel and Colon: A Systematic Review of the Global Experience and Institutional Cohort Analysis Detailing a Rare Clinical Entity. J Surg Oncol 2025; 131:671-684. [PMID: 39463145 DOI: 10.1002/jso.27958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 09/24/2024] [Indexed: 10/29/2024]
Abstract
INTRODUCTION Cutaneous melanoma is among the most common solid tumors to metastasize to the gastrointestinal (GI) tract. Literature summarizing the clinical experience and features of this unique pathology is lacking. METHODS A systematic review of the available literature reporting clinically salient features of melanoma metastases to the small and large intestines was conducted. Additionally, we surveyed our institutional experience of surgically treated melanoma metastasis to the small bowel and colon. A descriptive analysis was performed. Kaplan-Meier curves with log-rank tests were used to analyze time-to-event intervals. Univariable and multivariable Cox logistic regression models were generated to identify predictors of survival. RESULTS Over 100 studies including 1153 patients were included. GI metastases predominantly affected males, were in the small bowel/jejunum, equally presented as solitary and multiple lesions, and were generally not the first site of distant metastatic disease. The median time from primary lesion diagnosis to GI metastasis was 48 months. Analysis of our institutional cohort suggested that survival in patients receiving complete GI-specific surgical resection and immune checkpoint inhibitors (ICIs) was prolonged compared to palliative resection and without ICI therapy. Positive prognostic factors for survival following GI metastasis included fewer GI metastatic lesions, complete resection, and longer duration between primary tumor diagnosis and GI metastasis. CONCLUSIONS GI metastases are a sign of advanced metastatic melanoma. Clinical suspicion of metastatic involvement in patients with a history of melanoma who develop any abdominal symptoms or anemia should remain high. Receipt of complete surgical resection and ICIs may prolong survival in disseminated melanoma.
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Affiliation(s)
- Elliott J Yee
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Otto N Thielen
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ronald Truong
- Department of Surgery, Danbury Hospital, Danbury, Connecticut, USA
| | - Danielle Gilbert
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kylie Michel
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kasey L Couts
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Martin D McCarter
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Cash CJ, Pearson JM, Milikowski C, Feun L, Ritch C, Möller MG. Management of intramuscular melanoma metastases to the psoas. BMJ Case Rep 2024; 17:e257500. [PMID: 38839419 DOI: 10.1136/bcr-2023-257500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
We detail a case of a woman in her 40s with isolated melanoma skeletal muscle metastasis (MSMM) to the right psoas muscle. This patient underwent R0 surgical resection through a novel pelvic approach. She received subsequent adjuvant immunotherapy with Braftovi/Mektov along with adjuvant radiation. She is currently disease free at 9 months post surgery. Here, we describe our novel surgical approach including description of the tumour pathology. We explain our multidisciplinary management of MSMM consisting of a multidisciplinary surgical approach by surgical oncology, gynecological oncology and urology as well as multidisciplinary medical management by oncology, radiation oncology and pathology. Finally, we discuss best current options for therapeutic management.
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Affiliation(s)
- Charles Joseph Cash
- Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Matthew Pearson
- Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Clara Milikowski
- Department of Pathology and Laboratory Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Lynn Feun
- Department of Hematology and Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chad Ritch
- Department of Urologic Oncology, University of Miami Miller School of Medicine, Miami, Flordia, USA
| | - Mecker G Möller
- University of Miami Miller School of Medicine, Miami, Florida, USA
- Surgical Oncology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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3
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Maksimaityte V, Reivytyte R, Milaknyte G, Mickys U, Razanskiene G, Stundys D, Kazenaite E, Valantinas J, Stundiene I. Metastatic multifocal melanoma of multiple organ systems: A case report. World J Clin Cases 2022; 10:10136-10145. [PMID: 36246820 PMCID: PMC9561590 DOI: 10.12998/wjcc.v10.i28.10136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant melanoma is becoming more common among middle-aged individuals all over the world. Melanoma metastasis can be found in various organs, although metastases to the spleen and stomach are rare. Herein we present a rare metastatic multifocal melanoma, clinically and histologically mimicking lymphoma, with metastases of multiple organs.
CASE SUMMARY A 46-year-old Caucasian male with a history of nodular cutaneous malignant melanoma was presented with nausea, general weakness, shortness of breath, abdominal enlargement, and night sweating. The abdominal ultrasound revealed enlarged liver and spleen with multiple lesions. Computed tomography demonstrated multiple lesions in the lungs, liver, spleen, subcutaneous tissue, bones and a pathological lymphadenopathy of the neck. Trephine biopsy and the biopsy from the enlarged lymph node were taken. Tumor cells showed diffuse or partial positivity for melanocytic markers, such as microphthalmia - associated transcription factor, S100, HMB45 and Melan-A. The tumor harbored BRAF V600E mutation, demonstrated by immunohistochemical labelling for BRAF V600E and detected by real-time polymerase chain reaction test. Having combined all the findings, a diagnosis was made of a metastatic multifocal melanoma of the stomach, duodenum, liver, spleen, lungs, lymph nodes and bones. The patient refused treatment and died a week later.
CONCLUSION This case report highlights the clinical relevance of rare metastatic multifocal melanoma of multiple organ systems.
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Affiliation(s)
- Vaidota Maksimaityte
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Rosita Reivytyte
- Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gabriele Milaknyte
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ugnius Mickys
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gintare Razanskiene
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Domantas Stundys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Edita Kazenaite
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Jonas Valantinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ieva Stundiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
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Wankhede D, Grover S. Outcomes After Curative Metastasectomy for Patients with Malignant Melanoma: A Systematic Review and Meta-analysis. Ann Surg Oncol 2022; 29:3709-3723. [PMID: 35128602 DOI: 10.1245/s10434-022-11351-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2023]
Abstract
BACKGROUND Evidence on the role of curative metastasectomy (CM) for malignant melanoma (MM) patients is limited, especially in the current era of effective systemic therapy. A systematic review and meta-analysis were performed to ascertain the role of CM compared with incomplete or nonsurgical treatment for patients with MM. METHODS Medline, Embase, and Scopus databases were searched for studies investigating CM for MM until 30 September 2021. The review included studies that compared CM with no-CM and reported a hazard ratio (HR) after multivariate analysis for overall survival. A random-effects model with inverse variance was used to calculate pooled HR. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS For the final analysis, 40 studies including 31,282 patients (CM, 9958; no-CM, 21,324) were considered. Compared with no-CM, CM was associated with a significantly lower risk of death (HR, 0.42; 95% confidence interval [CI], 0.38-0.47; p < 0.00001). Subgroup analysis showed that the outcome was independent of the effective systemic therapy and anatomic location of metastasis. An unfavorable prognosis was associated with advancing age, elevated lactate dehydrogenase (LDH), male gender, prior stage 3 disease, multiple metastases and organ sites, and shorter disease-free interval. CONCLUSION Curative metastasectomy for MM is associated with a lower risk of death than non-curative treatment methods. Selection bias and underlying weakness of studies reduced the strength of evidence in this review. However, CM should be a part of the multimodality treatment of MM whenever technically feasible.
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Affiliation(s)
- Durgesh Wankhede
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Sandeep Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
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Syed HR, Shekar S, Aravantagi A. Melanoma and the Gastrointestinal (GI) Tract: Maintaining a High Index of Suspicion. Cureus 2021; 13:e13408. [PMID: 33628704 PMCID: PMC7894224 DOI: 10.7759/cureus.13408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Malignant melanoma is a life-threatening malignant tumor deriving from melanocytes, regarded as the most lethal form of skin cancer. One of the attributing factors to this fact is its propensity to metastasize to all organs of the human body. The strongest risk factors for melanoma include exposure to UV rays, family history of melanoma, and a prior history of melanoma. Malignant melanoma is thought to metastasize first to the local lymph nodes and then to secondary sites, most commonly skin, lung, and to the brain. This case highlights the severity of melanoma and its negative impact on the gastrointestinal tract. Patients with metastatic melanoma to the gastrointestinal tract can present with nonspecific, generalized gastrointestinal symptoms such as abdominal pain or constipation. Here we discuss the pathology, symptomatology, management options, and prognosis of metastatic melanoma of the gastrointestinal tract. The aim of this case is to promote a high index of suspicion of gastrointestinal metastasis in melanoma patients with gastrointestinal symptoms.
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Affiliation(s)
- Hassnain R Syed
- Internal Medicine, University of Kentucky, Bowling Green, USA
| | - Suman Shekar
- Internal Medicine, University of Kentucky, Bowling Green, USA
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Surgical treatment of melanoma metastases to the small bowel: A single cancer referral center real-life experience. Eur J Surg Oncol 2020; 47:409-415. [PMID: 32917431 DOI: 10.1016/j.ejso.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Treatment of metastatic melanoma has rapidly changed during the last years, and patients often require a multidisciplinary approach to achieve effective results. We aimed to assess the survival benefit achieved through surgical approach to patients with small bowel (SB) metastases from cutaneous melanoma, to emphasize the potential role of surgery in association with novel therapies. METHODS Ninety consecutive patients with cutaneous melanoma diagnosed as having resectable SB metastases from 1995 to 2015 were retrospectively investigated. RESULTS Median age at surgery of melanoma metastases was 53.4 years. Among 30 patients who had a curative-intent resection, the 5- and 10-year survival rates were 61% and 54%, respectively, while among 60 patients treated with a palliative surgery the corresponding rates were both 4%. Among 29 patients, for whom the interval time between the occurrence of SB metastases and the previous surgical event on GI tract was ≥36 months, the 5-year overall survival rate was 42%; for 56 patients who had an interval time <36 months the corresponding survival rate was 14%. Within the whole series, an absence of any residual disease after surgery (R0) was a factor affecting better survival, regardless of the evidence of metastases in other organs. CONCLUSION Our observational data showed that surgical treatment for patients with SB metastases from melanoma might increase survival, but further studies are needed to confirm this finding. In the age of novel available therapies, the increase in survival time given by surgery may offer important chances for patients to benefit from systemic therapies.
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8
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Ahmed M, Abbas H, Abdulsalam M, Johna S, Saeed R. Small Bowel Intussusception Caused by Metastatic Melanoma: A Case Report. Cureus 2019; 11:e5251. [PMID: 31572636 PMCID: PMC6760880 DOI: 10.7759/cureus.5251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intussusception, as a rare cause of small bowel obstruction, can be secondary to benign or malignant pathology. Malignant lesions causing intussusception can be primary or metastatic lesions. Metastasis can occur many years later. We present a case of metastatic melanoma in a 69-year-old man as the underlying etiology of his intussusception. The patient had laparoscopic Roux-en-Y gastric bypass four years prior to his presentation and did recall excision of a skin melanoma at age 64. Laparoscopic or open surgical resection is the best therapeutic option in cases such as this.
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Affiliation(s)
| | - Husain Abbas
- Advanced and Bariatric Surgery, Memorial Hospital, Jacksonville, USA
| | | | - Samir Johna
- Surgery, Loma Linda University School of Medicine, California, USA
| | - Rasha Saeed
- Surgery, Arrowhead Regional Medical Center, Fontana, USA
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9
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Melanoma Metastatic to the Jejunum Diagnosed by Double-Balloon Enteroscopy. ACG Case Rep J 2019; 6:e00109. [PMID: 31616774 PMCID: PMC6722337 DOI: 10.14309/crj.0000000000000109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/28/2019] [Indexed: 11/29/2022] Open
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Liu X, Feng F, Wang T, Qin J, Yin X, Meng G, Yan C, Xing Z, Duan J, Liu C, Liu J. Laparoscopic pancreaticoduodenectomy for metastatic pancreatic melanoma: A case report. Medicine (Baltimore) 2018; 97:e12940. [PMID: 30383642 PMCID: PMC6221747 DOI: 10.1097/md.0000000000012940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/25/2018] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Pancreatic metastases from other malignant tumors are an uncommon clinical condition and account for approximately 2% of all pancreatic malignancies. The most common primary malignancy that metastasizes to pancreas is renal cell cancer. We reported a rare clinical case of metastatic melanoma to pancreas who underwent a successful laparoscopic pancreaticoduodenectomy (LPD) at our department. PATIENT CONCERNS A 54-year-old Chinese man complaining an unexplained jaundice was found to have a pancreatic mass and he was diagnosed with cutaneous melanoma (CM) 6 years ago. DIAGNOSES Contrast-enhanced computed tomography (CECT) revealed a solid hypovascular mass measuring about 3.1 × 2.4 cm localized at the junction of pancreatic head and uncinate process, which compressed the lower common bile duct resulting in expansion of the upstream bile ducts. INTERVENTIONS We performed an LPD and regional lymphadenectomy on this patient. OUTCOMES This patient was discharged home on postoperative day 19. Postoperative pathological results revealed a malignant melanoma with negative margins. Immunohistochemical (IHC) findings also suggested a malignant pancreatic tumor accompanied by necrosis and pigmentation, which confirmed the pathological diagnosis. Immunoreactivity was strongly positive for anti-S-100 protein (+++) and positive for anti-Vimentin (+). The cancer cells were negative for CEA, CK8/18, P53, Violin, CK19, SMA with Ki-67 over 40%. So this pancreatic mass was proved to be a metastatic pancreatic melanoma from the primary cutaneous lesion. After LPD, this patient was followed up by readmission to hospital every 2 month in the first half year. The serum bilirubin and tumor markers such as CA199 were normal. CECT and did not find any newly developed neoplasm at the pancreas or metastasis at other organs. At the last follow-up at 6 months after LPD, the patient's general condition was acceptable and the physical examination and imaging studies revealed no significant findings of melanoma. LESSONS Metastatic pancreatic tumors are often associated with well-defined margins, tumor necrosis, enhancement, and distant metastases without pancreatic duct dilatation and parenchymal atrophy. As the most common type of metastatic pancreatic tumor, renal cell cancers tend to have higher attenuation values than that of primary pancreatic cancer, while they had similar attenuation values on the portal phase. Primary pancreatic cancer was always associated with an elevated CA199, total bilirubin, and fasting plasma glucose levels. Surgical resection for metastases to pancreas should be aggressively considered in selected patients due to its unique value of providing palliation and a chance to cure. For patients with unresectable lesions, new therapeutic protocols should be recommended such as the combination of BRAF with MEK inhibitor and PD-1 blocker with or without ipilimumab.
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Affiliation(s)
- Xueqing Liu
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Feng Feng
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Tianyang Wang
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Jianzhang Qin
- Second Hospital of Hebei Medical University, Shijiazhuang
| | | | | | - Changqing Yan
- Second Hospital of Hebei Medical University, Shijiazhuang
| | | | - Jiayue Duan
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Chen Liu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianhua Liu
- Second Hospital of Hebei Medical University, Shijiazhuang
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Silva S, Tenreiro N, Melo A, Lage J, Moreira H, Próspero F, Avelar P. Metastatic melanoma: An unusual cause of gastrointestinal bleeding and intussusception-A case report. Int J Surg Case Rep 2018; 53:144-146. [PMID: 30396125 PMCID: PMC6216089 DOI: 10.1016/j.ijscr.2018.10.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Malignant melanoma is responsible for 1-3% of all malignancies being the gastrointestinal tract one of the most common metastatic locations. PRESENTATION OF CASE We present the case of a 71-year old male with previous history of cutaneous melanoma. Seven years later, while being studied due to suspected small bowel bleeding, he developed small bowel obstruction after being submitted to double balloon enteroscopy. Further investigation revealed small bowel intussusception. He was taken up for emergency laparotomy that confirmed ileal intussusception secondary to an intraluminal mass. We performed segmental enterectomy with primary anastomosis. Histology confirmed intestinal melanoma metastasis. DISCUSSION Malignant melanoma frequently spreads to the gastrointestinal tract. The presentation is mainly asymptomatic and the diagnosis is often made only after complications develop. Small bowel intussusception and gastrointestinal bleeding are unusual presentations of metastatic melanoma, with few cases reported. Surgical resection not only provides symptom control but also positively affects prognosis. CONCLUSION Although usually asymptomatic, melanoma metastasis should always be considered in a patient with intestinal symptoms or chronic anemia and personal history of melanoma. Surgical resection is the treatment of choice, leading to an increase in overall survival.
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Affiliation(s)
- Sílvia Silva
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Nádia Tenreiro
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Ana Melo
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - José Lage
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Herculano Moreira
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Fernando Próspero
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Paulo Avelar
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
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A Case of Gastric Metastatic Melanoma 15 Years after the Initial Diagnosis of Cutaneous Melanoma. Case Rep Gastrointest Med 2018; 2018:7684964. [PMID: 30151286 PMCID: PMC6087584 DOI: 10.1155/2018/7684964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022] Open
Abstract
Melanoma is the most common cancer to metastasize to the gastrointestinal tract; however, metastasis to the stomach is a rare occurrence. We present the case of a patient with a history of melanoma of the chest wall 15 years prior to presentation who initially presented to the hospital with sepsis but was later found to have metastatic melanoma in the gastric cardia. This case illustrates the rare occurrence of metastatic melanoma to the stomach which occurred 15 years after the initial skin diagnosis of melanoma was made, its endoscopic appearance, and how the nonspecific symptoms frequently lead to a delayed diagnosis or one that is not made at all until after autopsy. For these reasons, endoscopy should be promptly performed if there is a suspicion of gastrointestinal metastatic melanoma.
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Zaiem F, Alrifai A. Anorectal Malignant Melanoma Presenting as Acute Pancreatitis. Am J Med Sci 2017; 354:327-328. [PMID: 28918842 DOI: 10.1016/j.amjms.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Feras Zaiem
- Mayo Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.
| | - Abdulah Alrifai
- Department of Cardiology, University of Miami/JFK Medical Center Palm Beach Regional Campus, Atlantis, Florida
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14
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Stodell M, Thompson JF, Emmett L, Uren RF, Kapoor R, Saw RPM. Melanoma patient imaging in the era of effective systemic therapies. Eur J Surg Oncol 2017. [PMID: 28625798 DOI: 10.1016/j.ejso.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Imaging plays a critical role in the current multi-disciplinary management of patients with melanoma. It is used for primary disease staging, surgical planning, and surveillance in high-risk patients, and for monitoring the effects of systemic or loco-regional therapies. Several different imaging modalities have been utilised in the past. Contemporary imaging practises vary geographically depending on clinical guidelines, physician preferences, availability and cost. Targeted therapies and immunotherapies have revolutionised the treatment of patients with metastatic melanoma over the last few years. With this have come new patterns of disease that were not observed after conventional therapies, and new criteria to assess therapeutic responses. In this article we review the role of imaging for patients with melanoma in the era of effective systemic therapies and discuss likely future developments.
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Affiliation(s)
- M Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia; Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - L Emmett
- Garvan Institute of Medical Research, Discipline of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - R F Uren
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Alfred Nuclear Medicine and Ultrasound, Newtown, NSW, Australia
| | - R Kapoor
- Mater Imaging, The Mater Hospital Sydney, North Sydney, NSW, Australia
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia; Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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15
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Hintze JM, O'Connor DB, Molony P, Neary PC. Distant melanoma causing small bowel obstruction. J Surg Case Rep 2017; 2017:rjx020. [PMID: 28458829 PMCID: PMC5400442 DOI: 10.1093/jscr/rjx020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Small bowel obstructions (SBOs) are common. Adhesions make up the majority of cases at 84.9%, followed by abdominal herniae and malignancies. A 71-year-old female presented with total constipation, abdominal distension, on a background of resected cutaneous melanoma nine years prior. A CT-scan showed small bowel intussusception and disseminated mucosal-enhancing lesions consistent with metastases. She was brought to the operating theatre where six areas of intussusception were identified and manually reduced. Biopsies confirmed the diagnosis of melanoma. Melanoma of the gastrointestinal tract (GIT) is rare, with most cases occurring as metastasis from cutaneous lesions. Melanomas of the GIT are usually asymptomatic in their early stages, and are often diagnosed when complications, such as obstruction or perforation occur. Management of such cases consists mainly of surgical intervention to resolve the complication. In people who present with SBO without previous surgeries or herniae, a malignant cause must be considered.
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Affiliation(s)
- Justin M Hintze
- Department of Surgery, AMNCH, Tallaght Hospital, Dublin 24, Ireland
| | - Donal B O'Connor
- Department of Surgery, AMNCH, Tallaght Hospital, Dublin 24, Ireland.,School of Medicine, University of Dublin, Trinity College, Dublin 2, Ireland
| | - Peter Molony
- Department of Pathology, AMNCH, Tallaght Hospital, Dublin 24, Ireland
| | - Paul C Neary
- Department of Surgery, AMNCH, Tallaght Hospital, Dublin 24, Ireland
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Lasithiotakis K, Zoras O. Metastasectomy in cutaneous melanoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:572-580. [PMID: 27889195 DOI: 10.1016/j.ejso.2016.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/28/2022]
Abstract
Metastasectomy remains the only treatment in malignant melanoma to offer complete pathologic response within a few days of in-hospital stay. It has been historically associated with the highest survival rates in the literature reported for patients of this stage. However, only a minority of patients are amenable to curative resection of distant metastatic disease. This patient group exhibit slow growing oligometastases as indicated by: a. Long disease free interval after treatment of their primary tumours and b. An exhaustive preoperative work up with the use of PET/CT and MRI scans. Only complete resection of all metastases is associated with long term survival and debulking should not be attempted. Metastasectomy has also been shown to offer significant palliation in cases of gastrointestinal bleeding or obstruction. The timing and the sequencing of surgery in the modern multimodal targeted treatment of melanoma is still unclear and warrants further investigation.
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Affiliation(s)
| | - O Zoras
- Department of Surgical Oncology, University of Crete, Greece.
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Prabhakaran S, Fulp WJ, Gonzalez RJ, Sondak VK, Kudchadkar RR, Gibney GT, Weber JS, Zager JS. Resection of Gastrointestinal Metastases in Stage IV Melanoma: Correlation with Outcomes. Am Surg 2016. [DOI: 10.1177/000313481608201128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognosis of patients with gastrointestinal (GI) melanoma metastases is poor. Surgery renders select patients disease free and/or palliates symptoms. We reviewed our single-institution experience of resection with GI melanoma metastases. A retrospective review was performed on patients who underwent surgery for GI melanoma metastases from 2007 to 2013. Fifty-four patients were identified and separated based on completeness of resection into curative 13 (24%) and palliative 41 (75.9%) groups. Thiry-six (63.2%) were symptomatic preoperatively with bleeding and/or obstruction/pain with 91.7 per cent achieving objective symptom relief. Thirty-day operative mortality was 0 per cent. The most common complication was wound infection (n = 5); major complications like anastomotic leak (n = 1) were uncommon. With a median follow-up of 9.5 months (range 0.2–75.8), median overall survival was not reached (curative) versus 9.53 months (palliative group). Median recurrence-free and progression-free survival after resection were 18.89 and 1.97 months in the curative versus palliative groups, respectively. On multivariate analysis, resection to no clinical evidence of disease (P = 0.012) and presence of single metastases (P = 0.031) were associated with improved overall survival. Surgery for GI metastases from melanoma provides symptomatic relief without major morbidity. Fewer metastases and curative resection were associated with improved survival.
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Affiliation(s)
- Sangeetha Prabhakaran
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William J. Fulp
- Department of Biostatistics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Statistical Center For HIV/AIDS Research & Prevention
| | - Ricardo J. Gonzalez
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vernon K. Sondak
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ragini R. Kudchadkar
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Geoffrey T. Gibney
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Hematology and Medical Oncology, Georgetown- Lombardi Comprehensive Cancer Center, District of Columbia
| | - Jeffrey S. Weber
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Hadjinicolaou AV, Hadjittofi C, Athanasopoulos PG, Shah R, Ala AA. Primary small bowel melanomas: fact or myth? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:113. [PMID: 27127766 DOI: 10.21037/atm.2016.03.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Small bowel melanoma (SBM) is a rare entity, which often evades diagnosis and therefore presents late. Its origin, whether arising primarily or metastatically from an unidentified or regressed primary cutaneous melanoma, remains debatable. In this report, we present a rare case of primary SBM and review the current literature. A 60-year-old man presented with melena and microcytic anemia. A series of investigations including abdominal ultrasonography (US), esophago-gastro-duodenoscopy (EGD) and colonoscopy were normal. Abdominal computed tomography revealed no specific pathology. Subsequent capsule endoscopy identified a jejunal mass, which was confirmed on laparotomy, was resected, and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. This report discusses gastrointestinal (GI) malignant melanoma, and examines the evidence both for and against the existence of true primary vs. metastatic disease. Furthermore, this case highlights the capabilities of capsule endoscopy in identifying an extremely rare GI tumor, which evaded other diagnostic modalities. Finally, the origins and pathophysiology of this rare cancer are evaluated, with the aim of promoting early diagnosis and treatment, and therefore improving current poor outcomes.
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Affiliation(s)
- Andreas V Hadjinicolaou
- 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK
| | - Christopher Hadjittofi
- 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK
| | - Panagiotis G Athanasopoulos
- 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK
| | - Rahul Shah
- 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK
| | - Aftab A Ala
- 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK
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Abstract
The surgical management of melanoma has undergone considerable changes over the past several decades, as new strategies and treatments have become available. Surgeons play a pivotal role in all aspects of melanoma care: diagnostic, curative, and palliative. There is a high potential for cure in patients with early-stage melanoma and the selection of an appropriate operation is very important for this reason. Staging the nodal basin has become widespread since the adoption of sentinel lymph node biopsy (SLNB) for the management of melanoma. This operation provides the best prognostic information that is currently available for patients with melanoma. The surgeon plays a central role in the palliation of symptoms resulting from nodal disease and metastases, as melanoma has a propensity to spread to almost any site in the body.
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Affiliation(s)
- Vadim P Koshenkov
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA.
| | - Joe Broucek
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
| | - Howard L Kaufman
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
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20
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Ettahri H, Elomrani F, Elkabous M, Rimani M, Boutayeb S, Mrabti H, Errihani H. Duodenal and gallbladder metastasis of regressive melanoma: a case report and review of the literature. J Gastrointest Oncol 2015; 6:E77-81. [PMID: 26487955 DOI: 10.3978/j.issn.2078-6891.2015.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Malignant melanoma involving the gastrointestinal (GI) tract may be primary or metastatic. Small bowel is the commonest site of GI metastases from cutaneous malignant melanoma, metastatic lesion in the gallbladder is extremely rare. CASE PRESENTATION This case report describes the presentation of metastatic melanoma in duodenum and gallbladder. A 45-year-old man has presented melena with intermittent abdominal pain. On physical examination we found a small lesion between the fourth and fifth toes, associated with inguinal lymph node. An Abdominal ultrasound revealed diffuse duodenal thickening. Upper endoscopy was performed and discovered an ulcerative lesion in the second part of the duodenum. The biopsy with immunohistochemical stains was in favor of a duodenal location of melanoma. Computed tomography (CT) revealed many circumferential thickening of ileal loops associated with a nodular lesion in the anterior wall of the gallbladder. The patient was treated by palliative chemotherapy. DISCUSSION Malignant melanoma of the GI tract may be primary or secondary. The small bowel is the most affected, but it's rare in the gallbladder. The clinical presentation can mimic the other intestinal tumors, and the diagnosis is based on imaging; CT scan and GI endoscopy have a key role on the diagnosis, and the treatment depends on the location and the number of lesions. CONCLUSIONS Metastases of melanoma in the GI tract are uncommon, the diagnosis must be suspected in any patient with a history of melanoma with digestive signs.
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Affiliation(s)
- Hamza Ettahri
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Fadwa Elomrani
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Mustapha Elkabous
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Mouna Rimani
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Saber Boutayeb
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Hind Mrabti
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
| | - Hassan Errihani
- 1 Department of Medical Oncology, National Institute of Oncology, Rabat 10000, Morocco ; 2 Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat 8007, Morocco ; 3 Centre de Pathologie Hassan, Rabat, Morocco
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Michalinos A, Felekouras E, Athanasiou A, Tsaparas P, Mantas D, Kouraklis G. Melanoma Metastases to Gastrointestinal Tract. Am Surg 2015. [DOI: 10.1177/000313481508100510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Adamantios Michalinos
- Department of Surgery Laikon University Hospital National and Kapodistrian University of Athens Athens, Greece
| | - Evangelos Felekouras
- Department of Surgery Laikon University Hospital National and Kapodistrian University of Athens Athens, Greece
| | - Antonios Athanasiou
- Department of Surgery Laikon University Hospital National and Kapodistrian University of Athens Athens, Greece
| | - Panayiotis Tsaparas
- Department of Surgery Laikon University Hospital National and Kapodistrian University of Athens Athens, Greece
| | - Dimitrios Mantas
- Department of Surgery Faculty of Medicine Laikon University Hospital, National and Kapodistrian University of Athens Athens, Greece
| | - Grigorios Kouraklis
- Department of Surgery Faculty of Medicine Laikon University Hospital, National and Kapodistrian University of Athens Athens, Greece
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Conversano A, Macina S, Indellicato R, Lacavalla D, D'Abbicco D. Gastrointestinal bleeding as presentation of small bowel metastases of malignant melanoma: Is surgery a good choice? Int J Surg Case Rep 2014; 5:774-8. [PMID: 25262323 PMCID: PMC4189074 DOI: 10.1016/j.ijscr.2014.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022] Open
Abstract
We examine two case reports about bowel metastasis of malignant melanoma. We consider the several methods to make a diagnosis and we would promote gastrointestinal investigations in patients with melanoma. We underline the importance of regular follow-up and we would stress the role of surgeon in encouraging patients and supporting the easier way to do that in order to avoid “lost to follow-up”. We propose surgery as a good option to control melanoma disease even if in cases of spread involvement in order to remove the source of acute symptoms and improve quality of life. INTRODUCTION Melanoma shows a particular predilection in involving small intestine both in a single site and in multiple localization and acute or chronic gastrointestinal bleedings are often the first sign of tumour. PRESENTATION OF CASE We report two cases of GI metastases of malignant melanoma, one presented with only a big mass that cause intestinal obstruction and the other with a tumour spread throughout the small intestine that produce enterorrhagia. DISCUSSION Diagnosis and follow-up are very difficult: CT scan, PET-CT scan and capsule endoscopy should be complementary for the assessment of patients with GI symptoms and melanoma history. CONCLUSION What is the role of surgery? Several studies suggest metastasectomy to achieve both R0 results and palliative resolutions of acute symptoms, such as obstruction, pain, and bleeding.
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Affiliation(s)
- Angelica Conversano
- Università degli Studi di Bari, Unità Operativa di Chirurgia Generale "G. Marinaccio", Azienda Ospedaliera Policlinico di Bari, Piazza G. Cesare 1, 70124 Bari, Italy.
| | - Simona Macina
- Università degli Studi di Bari, Unità Operativa di Chirurgia Generale "G. Marinaccio", Azienda Ospedaliera Policlinico di Bari, Piazza G. Cesare 1, 70124 Bari, Italy
| | - Rocco Indellicato
- Università degli Studi di Bari, Unità Operativa di Chirurgia Generale "G. Marinaccio", Azienda Ospedaliera Policlinico di Bari, Piazza G. Cesare 1, 70124 Bari, Italy
| | - Domenico Lacavalla
- Università degli Studi di Bari, Unità Operativa di Chirurgia Generale "G. Marinaccio", Azienda Ospedaliera Policlinico di Bari, Piazza G. Cesare 1, 70124 Bari, Italy
| | - Dario D'Abbicco
- Università degli Studi di Bari, Unità Operativa di Chirurgia Generale "G. Marinaccio", Azienda Ospedaliera Policlinico di Bari, Piazza G. Cesare 1, 70124 Bari, Italy
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23
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Den Uil SH, Thomassen I, Vermeulen EGJ, Vuylsteke RJCLM, Stockmann HBAC, de Vries M. Small Bowel Perforation Caused by Advanced Melanoma. TUMORI JOURNAL 2014. [DOI: 10.1177/1636.17930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sjoerd H Den Uil
- Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Irene Thomassen
- Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands
| | | | | | | | - Mattijs de Vries
- Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands
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Malignant melanoma of the gastro-intestinal tract: a case series. Int J Surg 2014; 12:523-7. [PMID: 24576592 DOI: 10.1016/j.ijsu.2014.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/09/2014] [Accepted: 02/21/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Resection of gastrointestinal (GI) metastases of malignant melanoma (MM) offers a significant survival benefit. No adjuvant therapy has been shown to be effective in the treatment of these metastases. METHODS All resections of MM affecting the GI tract at a UK University teaching hospital between October 1999 and January 2013 were identified from a pathology database. Demographic, investigative, operative and outcome data were retrieved from hospital records. Survival analysis was performed. RESULTS Thirty patients were identified (median age 62.7 years). 3 patients underwent a second operation at a later date to resect further metastases. 6 patients (20.0%) presented with no identifiable cutaneous lesion. The average time to GI metastases was 52.0 months (range 4.9-139.8 months) for those with an identified cutaneous primary (n = 24). Two patients with initial cutaneous lesions with Breslow's thickness <1 mm developed GI metastases. Common presenting symptoms included abdominal pain (n = 8, 27.6%), GI bleeding (n = 5, 17.2%) and symptoms of GI tract obstruction (n = 4, 13.8%). CT scan was the most commonly performed investigation (96.6%). Over half of resections (54.5%, n = 18) included small bowel resection. Mortality at 2 and 5 years was 66.4% and 73.1%. Of the 3 patients who underwent a second resection of GI metastases, one is still alive after 26 months of follow up; 2 patients died after 32.8 and 18.6 months. CONCLUSIONS Clinicians should have a low threshold for investigating GI symptoms in patients with a history of malignant melanoma even in the case of early-stage primary disease. Re-resection should be considered in patients presenting with further GI metastases.
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Gavriilidis P, Efthimiopoulos G, Zafiriou G. Early solitary small bowel metastasis from stage I cutaneous melanoma. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:536-8. [PMID: 24367718 PMCID: PMC3869646 DOI: 10.12659/ajcr.889670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/06/2013] [Indexed: 11/10/2022]
Abstract
Male, 63 Final Diagnosis: Melanoma Symptoms: Gastrointesinal haemorrhage Medication: — Clinical Procedure: Enterectomy Specialty: Oncology
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
| | | | - Georgios Zafiriou
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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26
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Lianos GD, Messinis T, Doumos R, Papoudou-Bai A, Bali CD. A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report. J Med Case Rep 2013; 7:216. [PMID: 23971500 PMCID: PMC3766141 DOI: 10.1186/1752-1947-7-216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Malignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date. CASE PRESENTATION We report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man. CONCLUSIONS In the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, St Niarchou Av. Ioannina, 45110, Greece
| | - Thomas Messinis
- Department of Surgery, University Hospital of Ioannina, St Niarchou Av. Ioannina, 45110, Greece
| | - Rodamanthos Doumos
- Department of Surgery, University Hospital of Ioannina, St Niarchou Av. Ioannina, 45110, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, University Hospital of Ioannina, St Niarchou Av., Ioannina 45110, Greece
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, St Niarchou Av. Ioannina, 45110, Greece
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Metastatic Malignant Melanoma to the Colon: a Case Report and Review of the Literature. J Gastrointest Cancer 2013; 45:221-4. [DOI: 10.1007/s12029-013-9492-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Puskás T, Kovács L, Henits I. [Pancreatic metastases. Report of four cases and literature review]. Orv Hetil 2013; 154:426-30. [PMID: 23477897 DOI: 10.1556/oh.2013.29565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors present the history of 4 patients with pancreatic metastases revealed by CT and MR during the last 2 years. In 2 patients pancreatic metastases developed more than 10 years after the primary renal neoplasm was diagnosed. In the other two patients (one with non small cell lung cancer and one with non-Hodgkin disease) pancreatic metastases developed shortly after the diagnosis of the primary malignancy. According to literature data metastases in the pancreas are rare. The authors conclude that the symptoms and imaging features of pancreatic metastases are variable and, therefore, non-invasive imaging diagnosis is difficult. To resolve this problem a thorough scrutiny of the medical history of the patients and functional imaging methods may be helpful.
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Affiliation(s)
- Tamás Puskás
- Vas megyei Markusovszky Lajos Általános Rehabilitációs és Gyógyfürdő Kórház és Egyetemi Oktatókórház Zrt. Radiológiai Osztály Szombathely Markusovszky.
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Trout AT, Rabinowitz RS, Platt JF, Elsayes KM. Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread. World J Radiol 2013; 5:25-32. [PMID: 23494131 PMCID: PMC3596608 DOI: 10.4329/wjr.v5.i2.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/30/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the frequency, typical and atypical locations and patterns of melanoma metastases identifiable by computed tomography (CT) in the abdomen and pelvis.
METHODS: We performed a retrospective review of index CT examinations of the abdomen and pelvis in patients with melanoma and recorded all findings suggestive of metastatic disease.
RESULTS: Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases. Pelvic metastases are more common with lower extremity primaries (accounting for 70% of cases with pelvic metastases) but 5% of patients with supraumbilical primaries also had pelvic metastases.
CONCLUSION: The distribution of metastatic melanoma in the abdomen and pelvis that we have defined should help guide the interpretation of CT exams in these patients.
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Gavriilidis P, Goupou E. Solitary metachronous splenic metastasis from cutaneous melanoma. BMJ Case Rep 2012; 2012:bcr-2012-007317. [PMID: 23104633 DOI: 10.1136/bcr-2012-007317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Melanoma has been found to metastasise to the spleen, usually in cases of disseminated disease. Solitary splenic metastasis from cutaneous melanoma is very rare. Herein we report the case of a 43-year-old man who developed solitary splenic metastasis from cutaneous melanoma. The patient was operated for T(4b) N(1a) Mo superficial spreading melanoma of the anterior thoracic wall. He subsequently underwent left axillary lymph node dissection due to a positive sentinel lymph node. The 33 retrieved lymph nodes were negative for metastasis. The patient received adjuvant therapy with high-dose interferon α-2b. After 27 months and during the follow-up visit an increasing lactate dehydrogenase serum level was observed. Furthermore, CT of the whole body revealed a solitary hypodense tumour of the spleen 9 cm×6 cm. Curative splenectomy was performed and the histopathological report confirmed metastatic melanoma to the spleen.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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31
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Abstract
Traditionally, distant metastatic melanoma has a poor prognosis owing to lack of efficacious, U.S. Food and Drug Administration-approved systemic therapy and the limited use of surgical resection as a therapeutic option. More recently, new biological therapies such as vemurafenib (Zelboraf) and ipilimumab (Yervoy) have shown strong promise and dramatically improved the landscape of stage IV melanoma therapy. Although there are numerous single-institution studies advocating the role for therapeutic surgical intervention, many remain skeptical of nonpalliative surgery for metastatic melanoma. Surgical resection of advanced melanoma has been proven to be effective as long as all disease is removed (R0). Patient selection is paramount. The combination of newer systemic therapies and surgical resection is currently under investigation. Understanding the tumor biology of melanoma and its mechanism of metastatic spread is essential to developing the most efficacious treatment strategy.
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Szynglarewicz B, Ekiert M, Forgacz J, Halon A, Skalik R, Matkowski R. The role of surgery in the treatment of colorectal metastases from primary skin melanoma. Colorectal Dis 2012; 14:e305-11. [PMID: 22251405 DOI: 10.1111/j.1463-1318.2012.02940.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The study assessed the role of colorectal surgery in the treatment of metastatic melanoma and identified patients who can most benefit from surgical resection. METHOD A retrospective analysis was made of 34 consecutive patients with skin melanoma who underwent surgical resection of large bowel metastasis. RESULTS The median disease-free interval between diagnosis of the primary and metastatic melanoma was 24 (7-98) months. Nine (27%) patients underwent emergency surgery for obstruction and 25 (73%) had an elective procedure. Resection with curative intent was performed in 14 (41%) and palliative resection in 20 (59%) patients. There was no postoperative mortality and morbidity occurred in 9%. The median survival following surgery was 11.5 (4-68) months. The 1-, 2- and 5-year survival rates were 50%, 32% and 17% respectively. Median survival was significantly increased in patients without extra-abdominal metastases, with no evidence of non-large-bowel metastases, if the disease-free interval was longer than 24 months and when curative resection was performed. In multivariate analysis, an apparently complete or palliative resection and the absence or presence of extra-abdominal metastases were the most important prognostic factors. CONCLUSION An aggressive surgical approach to large bowel metastatic melanoma results in good palliation and effective relief of symptoms with acceptable morbidity and mortality.
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Affiliation(s)
- B Szynglarewicz
- Department of Surgical Oncology, Lower Silesian Oncology Center - Regional Comprehensive Cancer Center, Wroclaw, Poland.
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Gutman H, Ben-Ami E, Shapira-Frommer R, Schachter J. Multidisciplinary management of very advanced stage III and IV melanoma: Proof-of-principle. Oncol Lett 2012; 4:307-310. [PMID: 22844375 DOI: 10.3892/ol.2012.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/19/2012] [Indexed: 11/06/2022] Open
Abstract
Patients with potentially resectable advanced stage III and IV melanoma are a selected subgroup that gain maximal advantage if treated in a melanoma center. Surgery combined with chemo/chemobiotherapy may yield durable remission and long-term palliation. Thirty-seven non-randomly selected patients underwent systemic therapy with the aim of consolidating treatment by surgery. Data were collected prospectively, and analyzed retrospectively. The median follow-up from diagnosis was 50 (3-307) months and 15 (1-156) months when calculated from the last intervention. Twenty-two males and 15 females, with a median age at diagnosis of 44 (20-71) years, with 13 trunk, 13 extremity, 3 head and neck and 8 unknown primary melanomas were included. There were 17 stage III and 20 stage IV patients with a median Breslow thickness of 3.7 (0.45-26) mm. Chemo/chemobiotherapy achieved 7 clinical complete responses (cCRs), 28 partial responses (PRs) and 2 instances of stable disease. Six of the 7 cCRs were operated on, securing pathological complete response in 5 and PR in one. Four of these five and the PR patient still have no evidence of disease (NED). Twenty-one of 30 PR patients were rendered NED by surgery; 14 of these 21 patients succumbed to melanoma, and one is alive with stable disease. Overall, 11 of 37 patients have not succumbed to melanoma, with a median of 72 (14-156) months survival following the last intervention. Of the eight patients with unknown primary melanomas, five have not succumbed to melanoma, with a median of 89 (30-156) months survival following the last intervention. Patients with marginally resectable stage III and IV melanoma have a significant 30% chance, according to this series, for durable remission if treated by a multidisciplinary team in a melanoma center using induction chemobiotherapy and surgery. Results are more favorable for patients with an unknown primary lesion. In view of the currently approved new effective treatments for melanoma, this study may be considered a proof-of-principle investigation, enabling long-term remissions by combining induction therapy and surgery.
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Affiliation(s)
- Haim Gutman
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Israel
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Patti R, Cacciatori M, Guercio G, Territo V, Di Vita G. Intestinal melanoma: A broad spectrum of clinical presentation. Int J Surg Case Rep 2012; 3:395-8. [PMID: 22659121 DOI: 10.1016/j.ijscr.2012.03.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/20/2012] [Accepted: 03/23/2012] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Small intestine melanomas are rare and the most of them are metastases from primary cutaneous neoplasms. PRESENTATION OF CASE Below, we report two cases of small intestine metastatic melanoma with very different clinical presentation. DISCUSSION Still now, primary versus metastatic origin is often unclear. Small bowel melanoma is often asymptomatic. However, clinical picture can be various; it may occurs with non specific symptoms and signs of gastro-intetstinal involvement, like chronic abdominal pain, occult or gross bleeding and weight loss, or with an emergency picture due to intestinal intussusception, obstruction or, rarely, perforation. CONCLUSION Small bowel melanoma is rare and the diagnosis done late. Imaging techniques are recommended in order to obtain early diagnosis of gastrointestinal metastases.
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Affiliation(s)
- Rosalia Patti
- Surgical Unit of the Department of Surgical and Oncological Science, University of Palermo, Italy
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Sperti C, Polizzi ML, Beltrame V, Moro M, Pedrazzoli S. Pancreatic resection for metastatic melanoma. Case report and review of the literature. J Gastrointest Cancer 2011; 42:302-306. [PMID: 20524082 DOI: 10.1007/s12029-010-9169-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Pancreatic metastasis from several malignancies are increasingly encountered in clinical practice, and the usefulness of surgical resection has been suggested for certain neoplasms. Isolated pancreatic metastasis from malignant melanoma is a rare occurrence, and the role of surgery as an adjunct to systemic therapy for melanoma metastatic to a solitary or multiple sites is still debated. CASE REPORT We report a patient with melanoma of unknown primary site metastatic simultaneously to the lung and pancreas 3 years after axillary lymph node dissection. Distal pancreatectomy with splenectomy and video thoracoscopic assisted resection of pulmonary metastasis were performed. The postoperative course was uneventful, but 6 months after surgery, the patient experienced single pulmonary recurrence. During chemotherapy with different drugs, pulmonary lesion remained stable for 1 year, and no abdominal recurrence occurred. After then, the size of the lesion progressively increased and a second metastasis occurred in the lung. Five months later, brain metastases occurred, and the patients died 24 months after surgery. Sixteen pancreatic resections for metastatic malignant melanoma, reported with adequate clinical details, were also retrieved from the literature. CONCLUSION In spite of the very limited experience, it appears that surgical resection is only a palliative procedure, because long-term survival is a rare event. However, considering the lack of effective systemic therapy, surgery may be considered as a part of an aggressive multidisciplinary approach in selected cases with malignant melanoma metastatic to single or multiple visceral sites.
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Affiliation(s)
- Cosimo Sperti
- Department of Medical and Surgical Sciences, 4th Surgical Clinic, University of Padua, Padova, Italy.
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Sbitti Y, Fadoukhair Z, Kadiri H, Oukabli M, Essaidi I, Kharmoum S, M'rabti H, Albouzidi A, Ichou M, Errihani H. Diagnostic challenge for ovarian malignant melanoma in premenopausal women: primary or metastatic? World J Surg Oncol 2011; 9:65. [PMID: 21682901 PMCID: PMC3157440 DOI: 10.1186/1477-7819-9-65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 06/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the ovary, metastatic malignant melanoma may be confused with primary malignant melanoma and presents a diagnosis challenge. Most cases are associated with disseminated diseases and poor prognosis. We present this case report of a metastatic ovarian malignant melanoma simulating primary ovarian cancer. CASE REPORT A 45-year-old premenopausal woman was incidentally found to have an abdominal mass, 3 years after removal of a cutaneous melanoma lesion. Ultrasound and CT scan revealed left two solid masses, which were found to be an ovarian tumor at laparotomy. Left oophorectomy was performed. Histopathology and immunohistochemistry showed melanoma metastasis to the ovary. Nine months later, the patient developed epilepsy and confusion. Magnetic Resonance Imaging showed unique Wright frontal lobe lesion. She underwent stereotactic radio surgery and dacarbazine monotherapy. For months later, the patient is died from disseminate disease progression. CONCLUSION Ovarian metastasis is an unusual presentation of cutaneous melanoma and the prognosis was dismal. As illustrated by this case report, a differential diagnosis of a metastatic malignant melanoma must be considered.
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Affiliation(s)
- Yassir Sbitti
- Department of Medical Oncology, University Military Hospital, Rabat, Morocco.
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Caudle AS, Ross MI. Metastasectomy for stage IV melanoma: for whom and how much? Surg Oncol Clin N Am 2011; 20:133-44. [PMID: 21111963 DOI: 10.1016/j.soc.2010.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although the conventional paradigm for treating metastatic melanoma relies on systemic therapies, a surgical approach should be strongly considered in selected patients. A surgical approach may not be appropriate for all patients, but it can offer a rapid clearance of disease without the toxicity of systemic therapy. Patient selection is of paramount importance for surgery to be effective. The rationale for surgical intervention in the management of metastatic melanoma, selection factors to be considered, published results, and future directions are discussed in this article.
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Affiliation(s)
- Abigail S Caudle
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA.
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Trouillet N, Robert B, Charfi S, Bartoli E, Joly JP, Chatelain D. Gastric metastases. An endoscopic series of ten cases. ACTA ACUST UNITED AC 2010; 34:305-9. [PMID: 20627637 DOI: 10.1016/j.gcb.2010.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/25/2010] [Accepted: 01/25/2010] [Indexed: 01/13/2023]
Abstract
We report a series of ten cases of the clinical, endoscopic and pathological features of gastric metastases. Patients were six women and four men between 54 and 88 years old, with gastric metastases from breast carcinoma (4), lung carcinoma (4) and melanoma (2). Patients underwent an upper gastrointestinal endoscopy for epigastralgia (2), hematemesis (2), dysphagia (1) and anemia (5). On endoscopy, tumors appeared as nodules with a central ulceration (5), an ulceration (4) or simulating linitis plastica (1). Metastases were located in the cardia (2), fundus (5) and antrum (3). Primary tumors had been diagnosed between one day and 20 years before upper endoscopy. Eight patients had multivisceral metastases. The microscopic features of the gastric metastases resembled a primary gastric cancer in eight cases. Thanks to clinical data, the pathologist confirmed the diagnosis of gastric metastases on immunohistochemistry. Nine patients died in the eight-month follow-up period. Gastric metastases are rare, occur at a late stage of the neoplastic disease, and have a poor prognosis. Diagnosis of gastric metastases is difficult because they simulate primary gastric cancer on endoscopy and on microscopic examination. A correct diagnosis is based on good communication between gastroenterologists and pathologists.
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Affiliation(s)
- N Trouillet
- Service d'Anatomie Pathologique, CHU d'Amiens, Place Victor-Pauchet, 80054 Amiens cedex 01, France
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Harvey KP, Lin YHA, Albert MR. Laparoscopic resection of metastatic mucosal melanoma causing jejunal intussusception. Surg Laparosc Endosc Percutan Tech 2010; 20:e66-8. [PMID: 20393324 DOI: 10.1097/sle.0b013e3181d7e21a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 47-year-old female was seen in an outpatient surgical setting for intermittent obstructive symptoms and abdominal pain. Computed tomography scan and upper GI series showed typical findings of intussusception. Laparoscopic-assisted small bowel resection was carried out. Histologic diagnosis revealed malignant melanoma. The patient had a history of right maxillary sinus melanoma greater than 12 years before presentation. We report the first case of a jejunojejunal intussusception caused by metastatic sinonasal melanoma, and its subsequent laparoscopic-assisted resection.
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40
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[Small intestinal metastasis from malignant melanoma]. Presse Med 2010; 39:1344-5. [PMID: 20615658 DOI: 10.1016/j.lpm.2010.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 03/20/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022] Open
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Abstract
Primary surgical treatment should be considered for patients with metastatic melanoma. Because of the poor response of melanoma to chemotherapy or radiation therapy, surgery can be the best approach to quickly eliminate detectable disease and return the patient to normal activities. In properly selected patients, surgery can lead to significant palliation and prolongation of survival. This article reviews the principles of patient selection and the potential benefits of surgical management of melanoma metastatic to various sites. Novel adjuvant therapies are being developed to augment the benefits of surgical treatment of advanced melanoma in the future.
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Affiliation(s)
- Christopher J Hussussian
- Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, Plastic Surgery Associates, 22370 Bluemound Road, Waukesha, WI 53005, USA.
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Boutis A, Valeri R, Korantzis I, Valoukas D, Andronikidis I, Andreadis C. Delayed malignant melanoma recurrence simulating primary ovarian cancer: case report. World J Surg Oncol 2008; 6:124. [PMID: 19021897 PMCID: PMC2607274 DOI: 10.1186/1477-7819-6-124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 11/20/2008] [Indexed: 11/10/2022] Open
Abstract
Background Metastatic involvement of the ovary from malignant melanoma is uncommon and presents a diagnostic challenge. Most cases are associated with disseminated disease and carry a dismal prognosis. Delayed ovarian recurrences from melanoma may mimic primary ovarian cancer and lead to aggressive cytoreductive procedures. Case presentation A case of malignant melanoma in a premenopausal patient is presented with late abdominal and ovarian metastatic spread, where ascitic fluid cytology led to an accurate preoperative diagnosis and the avoidance of unnecessary surgical procedures. Conclusion Secondary ovarian involvement is associated with a poor prognosis and efforts should be made for adequate palliation. Pathologic diagnosis with non-invasive procedures is crucial in order to avoid unnecessary surgery. Surgical interventions may be undertaken only in selected cases of limited metastatic disease, where complete resection is expected
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Affiliation(s)
- Anastasios Boutis
- 3rd Department of Clinical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece.
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Mcloughlin JM, Zager JS, Sondak VK, Berk LB. Treatment Options for Limited or Symptomatic Metastatic Melanoma. Cancer Control 2008; 15:239-47. [DOI: 10.1177/107327480801500307] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patients who develop metastatic melanoma often have limited effective treatment options. However, a select group of patients will benefit from aggressive surgery or a multidisciplinary approach, depending on the site of metastasis. Methods The current literature was reviewed and summarized regarding the collective recommendations for staging and treating patients with metastatic melanoma. Results A thorough preoperative staging includes positron-emission tomography, MRI of the brain, and CT of the chest, abdomen, and pelvis. Tumor biology ultimately determines the success of intervention. A long disease-free interval is a good indicator of potential benefit from resection of metastatic disease. If surgery is performed, no less than a complete resection will affect the overall survival of the patient. Surgery and other multimodality treatment options can be used for symptomatic palliation but will not affect survival. Chemotherapy and radiation are often used to control the symptoms of brain and bony metastases but have limited if any impact on survival. Conclusions A select group of patients with metastatic melanoma will benefit from aggressive surgery. Identifying which patients will benefit from treatment requires good clinical judgment and a thorough radiologic evaluation to identify the true extent of disease.
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Affiliation(s)
| | - Jonathan S. Zager
- Cutaneous Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Vernon K. Sondak
- Cutaneous Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Immunology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Lawrence B. Berk
- Radiation Oncology Programs at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Surgery for melanoma metastases of the gastrointestinal tract: indications and results. Eur J Surg Oncol 2008; 35:313-9. [PMID: 18590949 DOI: 10.1016/j.ejso.2008.04.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 04/18/2008] [Indexed: 11/20/2022] Open
Abstract
AIM To assess survival, morbidity and mortality following therapeutic or palliative resection of gastrointestinal (GI) tract melanoma metastases. METHODS A retrospective case series of 117 patients who underwent surgical resection of GI melanoma metastases between 1981 and 2005 was reviewed. RESULTS The 117 patients underwent 142 operations for acute and/or sub-acute symptoms or for imminently symptomatic GI metastases detected radiologically. The intent of the surgery was palliative in 53 (37.3%) and therapeutic in 89 (62.7%) operations. The most common symptoms were due to anaemia (40.8%) or bowel obstruction (32.4%). The most frequently performed operation was small bowel resection (76.8%). Preoperative imaging and/or endoscopy were used in 83 cases, with computerised tomography (CT) being most frequent (85.5%). CT had a sensitivity of 68.8% when used alone to detect the presence of GI metastases in the study population. The mortality rate following GI resection was 1.4%, and 2.5% of patients had post-operative complications. Overall 5-year survival was 27%. On multivariate analysis, the presence of residual intraabdominal disease and the presence of non-GI metastases at the time of surgery or after surgery were the most significant prognostic indicators of survival. CONCLUSIONS Resection of GI melanoma metastases is safe, relieves symptoms and can achieve prolonged remission. In patients with limited disease, an aggressive surgical approach to symptomatic or imminently symptomatic GI melanoma metastases is warranted.
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Martinez SR, Young SE. A rational surgical approach to the treatment of distant melanoma metastases. Cancer Treat Rev 2008; 34:614-20. [PMID: 18556133 DOI: 10.1016/j.ctrv.2008.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/19/2008] [Accepted: 05/07/2008] [Indexed: 11/28/2022]
Abstract
The optimal treatment of melanoma involves multidisciplinary care. To many, this means surgical resection of early, localized disease and treatment of metastatic disease with chemotherapy, immunotherapy, or radiation. Because it is effective, results in little morbidity and may be repeated, surgery should have a central role in the treatment of selected patients with American Joint Committee on Cancer (AJCC) stage IV melanoma.
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Affiliation(s)
- Steve R Martinez
- Division of Surgical Oncology, Department of Surgery, UC Davis Cancer Center, 4501 X Street, Suite 3010, Sacramento, CA 95817, USA.
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Mosca PJ, Teicher E, Nair SP, Pockaj BA. Can surgeons improve survival in stage IV melanoma? J Surg Oncol 2008; 97:462-8. [PMID: 18270974 DOI: 10.1002/jso.20950] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Successful systemic management of stage IV melanoma continues to be elusive because of the paucity of effective therapies. This has fueled the continued interest in surgical resection. Several single-institution studies and a current, large, multi-institutional phase III trial have demonstrated a survival benefit for patients who underwent surgical resection for melanoma metastases. Incorporating these results into new approaches using multimodality treatment may enhance survival in patients with stage IV melanoma.
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Affiliation(s)
- Paul J Mosca
- Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA
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Abstract
Isolated metastases to the pancreas and spleen are a rare occurrence. When they are diagnosed, pancreatic metastases are most often from renal cell carcinoma, lung cancer, and breast cancer. The most common source of splenic metastases is gynecological in origin; the overwhelming majority is ovarian. If extensive staging studies reveal these metastases to be isolated, then curative resection may be warranted. This review will demonstrate that long-term survival may be achieved in patients with isolated metastases and a prolonged disease-free interval.
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Affiliation(s)
- Shayna L Showalter
- Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Collinson FJ, Lam TK, Bruijn WMJ, de Wilt JHW, Lamont M, Thompson JF, Kefford RF. Long-term Survival and Occasional Regression of Distant Melanoma Metastases after Adrenal Metastasectomy. Ann Surg Oncol 2008; 15:1741-9. [DOI: 10.1245/s10434-008-9836-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 01/10/2023]
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Vázquez Ruiz J, Alcázar López CF, Franco Campello M, Casajuana FL. [Ileal metastasis from melanoma of unknown origin]. Cir Esp 2007; 82:371-2. [PMID: 18053514 DOI: 10.1016/s0009-739x(07)71755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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