Surgery for melanoma metastatic to the gastrointestinal tract

Abstract

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.

Malignant Melanoma Metastasis as a Cause of Small-Bowel Perforation

“…Postmortem studies report the incidence of small-bowel metastases of malignant melanoma in patients withdisseminateddiseasein27-58%ofcases [2,3].Themean Tsilimparis/Menenakos/Rogalla/Braumann/ Hartmann intervalbetweeninitialdiagnosisandintestinalmetastasesis about43.8months(range21.6-54) [4].…”

“…Occultorgrossbleedingwithanemia(26-84%),unspecific abdominalpain(17-64%)andweightloss(10-47%)arethe mostcommonclinicalsymptomsofGITmelanomametastases.Ileusduetointussusceptionorobstructionhasalsobeen reportedasamanifestationofGITmetastaticmelanoma [3,[5][6][7].Small-bowelperforationasamanifestationofmelanoma metastasesisrare [3,6,8].…”

Malignant gastrointestinal melanomas of unknown origin: Should it be considered primary?

“…Usually being asymptomatic, such metastases are diagnosed premortem in 1.5%-4.49% of the patients [2][3][4] . GI metastases may not be clinically detected until after removal and potential cure of primary melanoma, mostly affecting the small bowel, the stomach and the colon [2][3][4][5][6][7][8] . However, there is a portion of GI melanomas without any documented evidence of a primary lesion in the skin or elsewhere, even after thorough examination [9] .…”

“…Surgical palliation in non-curable melanomas aims at relieving obstruction and/or bleeding [8,12] . Surgery, if curative, has a relatively low morbidity and mortality and long-term disease-free survival [2,4,7] . Systemic adjuvant therapy has a limited role.…”

Surgical Therapy of Cutaneous Melanoma

“…In other series, long-term survivors up to 20 years have been reported when undergoing surgical excision of a solitary GI metastasis. [59][60][61][62] …”