Objetivo: Apresentar um caso de melanoma de pele com metástase para o cólon expondo a evolução incomum da doença e os possíveis caminhos terapêuticos disponíveis. Descrição: Relato de caso de um paciente do sexo masculino, de 57 anos, que buscou o serviço da Santa Casa de São Paulo em 2015 com uma história prévia de melanoma em quirodactilo e antebraço ipsilaterais, foi então indicada e realizada a exérese da lesão e a biopsia identificou um melanoma acral, com margens livres. Foi então iniciado tratamento com Interferon. Nos dois anos seguintes, uma metástase pulmonar e uma recidiva na mão esquerda foram diagnosticados e ambas as biopsia confirmaram ser do melanoma.    Em 2018 uma tomografia de abdome evidenciou uma tumoração no cólon e a biopsia e imunohistoquímica confirmaram se tratar de melanoma. Foi então realizada uma cirurgia para retirada da parte afetada. Além disso, nesse mesmo ano, o paciente teve que ser submetido a amputação do braço esquerdo devido a nova recidiva local.  Em junho do ano seguinte, uma colonoscopia e uma tomografia de abdome apresentaram imagens compatível com recidiva em cólon, além de invasão gástrica e em contato com a cauda pancreática. Após reunião com a equipe de coloproctologia, foi contraindicado o procedimento cirúrgico. O paciente está recebendo cuidados paliativos da equipe da oncologia com tratamento medicamentoso.Comentários: o melanoma metastático em cólon é raro, sendo linfonodos, pulmões, fígado e cérebro os sítios mais comumente atingidos. Inúmeros trabalhos mostram o aumento da incidência mundial do melanoma. Cerca de 70% dos casos se originam de nevos melanocíticos pré-existentes, e os 30% restantes surgem de novo. Dada a agressividade do melanoma, a sobrevida depende de um diagnóstico e tratamento precoces. No entanto, em alguns casos, mesmo com o tratamento cirúrgico, quimioterápico e radioterápico adequados, a agressividade do câncer impede que tais tratamentos tenham resultados satisfatórios.Descritores: Melanoma, Neoplasias do colo, Neoplasias cutâneas, Metástase neoplásicaAbstract Objective: To present a case of metastatic skin melanoma in colon, exposing the unusual evolution of the disease and the therapeutic possibilities. Description: A report of a 57-year-old male patient that in 2015 came to Santa Casa with a previous history of ipsilateral chirodactyl and forearm melanoma. At the time it was indicated the excisional biopsy that identified acral melanoma with free margins. Interferon treatment was then started. Over the next two years, a pulmonary metastasis and a recurrence in the left hand were diagnosed and both biopsies confirmed to be melanoma. In 2018 an abdominal CT scan showed a tumor in the colon and biopsy and immunohistochemistry confirmed that it was melanoma. Surgery was then performed to remove the affected part. In addition, that same year, the patient had to undergo amputation of the left arm due to new local recurrence. In June of the following year, a colonoscopy and a CT scan showed images compatible with colon recurrence, as well as gastric invasion and contact with the pancreatic tail. After discussion with the coloproctology team, the surgical procedure was contraindicated. The patient is receiving palliative care from the oncology team using drug treatment. Comments: Metastatic melanoma in colon is quite rare, with lymph nodes, lungs, liver and brain being the most common sites of metastasis. Numerous studies show the increasing incidence of melanoma worldwide. About 70% originate from pre-existing melanocytic nevi, and the remaining 30% arise again. Given the aggressiveness of melanoma, survival depends on early diagnosis and treatment.Keywords: Melanoma, Colonic neoplasms, Skin neoplasm, Neoplasm Metastasis

IntroductionThe anatomical knowledge of bone depressions and elevations of the distal humerus region is important for planning surgical procedures. The supratrochlear septum, located superiorly to the trochlea, can be perforated, originating an anatomical variation known as supratrochlear foramen (STF). The occurrence rate of this variation is between 0% and 60% and reaches different ethnicities. The STF is commonly associated with the presence of a narrow medullary cavity, which could complicate some surgical procedures to correct fractures of the distal humerus region. In radiological evaluations, the presence of the STF can cause a wrong interpretation, being confused with a cystic or osteolytic lesion.ObjectiveMeasure anatomical structures present in the humerus distal region to determine the morphology of this region, in human adult humeri. Detect the presence of the STF and calculate its size.Material and methods48 dried humeri of brazilian male adult cadavers, were selected from the collection of the Department of Morphology of Santa Casa de São Paulo School of Medical Sciences. All humeri were submitted to several measurements, with the help of two digital calipers. The measurements taken are represented in figure 1. The study was performed by two independent observers, who did three measurements of each of the evaluated items, at different times and blindly, totaling six measurements per bone. The values obtained by the observers were submitted to statistical analysis (SPSS 21.0) in order to determine the intraobserver and interobserver correlations. The intraclass correlation coefficient (ICC) and the Pearson's correlation coefficient were used, respectively.ResultsOf the 48 dried humerianalized, 28 (58,33%) were right side and 20 (41,67%) were left side. The results of the measurements taken are presented in table 1. The Intraobserver and interobserver correlations are represented in tables 2 and 3, respectively. About the STF, it was found in 13 (27,09%) of 48 studied bones, six (46,15%) on right side and seven (53,85%) on left side. Our presence of STF was similar to the results found by 13 authors in the literature, variating from 19,20% to 39,00%. As demonstrated in tables 2 and 3, the measurements whose values are highlighted in green had intraobserver and interobserver correlation coefficients very high (r ≥ 0,9), unlike depression measurements (mainly the olecranon fossa), probably because of the difficulty to stipulate which is the exact location of its beginning and end.ConclusionThe interepicondylar distance, supretrochlear septum thickness and diameters of the STF, when present, were reproducible by the two observers, being considered the best measurements to describe this region. The presence of the STF in the analyzed humeri was relevant, showing that it is an anatomical variation relatively frequent. This fact should be known by all professionals who are involved in the diagnosis and treatment of affections of the humerus distal region, in order to choose the best therapeutic option to be followed.Support or Funding InformationPiBic CNPq 2018This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.