There appears to be a benefit to resection for patients with NCRNNE liver metastases. The degree of survival advantage is predicated by primary site.

Malignant blue nevus (MBN) is a rare melanocytic lesion and controversy exists whether it is a melanoma or a unique entity. We sought to establish clinical behavior using a large national registry. All patients with MBN and melanoma from 1973 to 2008 were identified in the Surveillance Epidemiology and End Results tumor registry. We performed comparative and survival analysis among the two tumor types. A total of 228,038 patients were identified (227,986 with melanoma and 52 with MBN). The mean age was 57.7 years. Both lesions had similar age of presentation (55.8 vs 55.7 years, P = 0.527), sex (male 50 vs 55%, P = 0.44), and nodal positivity rate (9.6 vs 5.4%, P = 0.22). MBNs were more likely to be nonwhite (11.8 vs 1.6%, P < 0.0001) and present with metastatic disease (15.2 vs 4%, P = 0.0028). MBN and melanoma had a similar survival (264 vs 240 months, P = 0.78) and remained similar when stratified by race (264 vs 242 months, P = 0.99) and stage (264 vs 256 months, P = 0.83). This is the largest study to date demonstrating similar clinical behavior and survival between patients with MBN and those with melanoma. We believe MBN is a variant of melanoma and suggest using a similar treatment algorithm as that of melanoma.

This is a case of a 59-year-old woman with Bouveret syndrome. An initial endoscopic approach to management is described. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula or a choledochoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocecal valve. Bouveret syndrome is a variant of gallstone ileus where the gallstone lodges in the duodenum or pylorus causing a gastric outlet obstruction. The endoscopic and surgical management of this process are important to keep in mind and may be evolving as endoscopic therapies improve.

Several options exist to palliate malignant obstruction (MBO), none of which have established consensus among surgeons. The purpose of this study was to establish outcomes of diverting stoma (DS), internal bypass (IB), and palliative resection (PR) for a tertiary academic referral surgical oncology service. All patients presenting to a surgical oncology service with malignant bowel obstruction over a 3-year period were identified. Records were reviewed to determine success of diversion, bypass, or resection and associated cost, length of stay (LOS), morbidity, and mortality. Forty-three patients undergoing palliative surgery were identified. The success of each approach was 80, 78, and 63 per cent for diversion, bypass, and resection, respectively. Major morbidity (63%), mortality (16%), and LOS (26 days) were greatest in those undergoing PR, but so was survival (8.4 months). DS and IB had comparable morbidity (40 and 33%), mortality (10 and 0%), and LOS (25 and 21 days), but survival was shorter for DS (5.3 vs 6.5 months). Cost of PR was significantly greater ($79,000) than both DS ($36,000) and IB ($51,000). Escalation in complexity of palliative measures for MBO results in improved survival but at significant cost both economically and physiologically. Quality of life should be discussed with patients when deciding how best to palliate their symptoms.

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