Pancreatic resection for metastatic melanoma

Abstract

BackgroundThe pancreas is an occasional site of metastases from melanoma. It may be the only location of metastatic disease, but more often the melanoma metastasises to other organs as well. Treatment options are somewhat limited, and the role of operative treatment is poorly de®ned. Case outlinesTwo patients presenting with abdominal pain were found to have pancreatic lesions. A 45-year-old woman had a pyloruspreserving pancreatoduodenectomy for a mass in the head of pancreas; concurrent liver nodules were treated by segmental liver resection. A 55-year-old man had a total pancreatectomy for multiple pancreatic tumours. Both patients gave a history of ocular melanoma, diagnosed >10 years previously. They had no evidence of malignancy elsewhere. Histology of resected specimens con®rmed metastatic melanoma with features consistent with an ocular primary. All resection margins were clear of malignancy, and no lymph node metastases were detected. At 6 months follow-up there were no signs of tumour recurrence. DiscussionComplete surgical resection offers potential cure in selected patients with metastatic melanoma involving the pancreas, when there is no evidence of widespread disease.

Metástasis única en el páncreas de melanoma de piel, resultados del tratamiento combinado con resección quirúrgica e inmunoterapia

“…También parecen tener un índice de resecabilidad más alto en comparación con el adenocarcinoma de páncreas; esto se debe a que los límites de las lesiones metastásicas tienden a estar mejor definidos 2,4,9 . Para los pacientes con lesiones no resecables, la cirugía ofrece una buena paliación, con mejora de la calidad de vida, y se asocia con un mínimo de morbilidad [2][3][4] . El papel de la cirugía, sin embargo, en el caso de las metástasis de melanoma al páncreas, es menos claro, ya que hay muy poca literatura disponible que demuestre la ventaja de supervivencia.…”

Cutaneous melanoma single metastasis to the pancreas: Results of combined treatment with surgical resection and immunotherapy

“…Most authors recommend surgery as the treatment of choice for pancreatic metastases that are amenable to resection since it appears to be the only treatment able to prolong survival 9,12 . In addition, pancreatic metastases seem to have a higher resectability index in comparison with pancreatic adenocarcinoma, owing to the fact that metastatic lesions borders tend to be better defined 2,4,9 . For patients with unresectable lesions, surgery still offers good palliation with the quality of life improvement and very low associated morbidity [2][3][4] .…”

“…In addition, pancreatic metastases seem to have a higher resectability index in comparison with pancreatic adenocarcinoma, owing to the fact that metastatic lesions borders tend to be better defined 2,4,9 . For patients with unresectable lesions, surgery still offers good palliation with the quality of life improvement and very low associated morbidity [2][3][4] . However, the role of surgery for melanoma metastases to the pancreas is less clear, since there is very scarce literature available demonstrating a survival advantage.…”

“…Pancreatic metastases commonly occur in patients with diffuse disease. Single metastasis is quite rare, and it has been described mostly in primary ocular melanoma 2 . On the other hand, metastatic melanoma has an unfavorable prognosis: 5-year survival for patients with a single metastasis is 12% (median survival of 11 months), whereas 5-year survival with multiple metastases is 0% (median survival of 4 months).…”

“…Traditionally, metastasectomy was deemed useless owing to a bad prognosis associated with highly extended disease. However, some patients with limited metastatic disease are able to survive for a reasonable period after surgery 2 , and there are even reports of cure 11 . This, together with an improvement in operative risk associated with the procedure demonstrated by many groups, has led to a renewed interest on surgical treatment of metastatic melanoma.…”