Isolated Metastatic Melanoma to the Gallbladder: Is Laparoscopic Cholecystectomy Indicated?

Abstract

Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. The surgical management seems to be indicated for patients with isolated and resectable gallbladder metastases to avoid symptoms or tumor complications. We report on a case of a young woman with an isolated metastatic gallbladder melanoma who presented with symptoms of acute cholecystitis. The patient underwent laparoscopic cholecystectomy (LC) and lymphadenectomy of the hepatoduodenal ligament. Histology was characteristic for metastatic malignant melanoma. Nodes were negative for metastases. We emphasize the appropriateness of a laparoscopic approach, once ruled out a widespread metastatic disease. It can be done with a remarkably low rate of complications. Gentle manipulation, avoidance of perforation, and use of a retrieval bag for the removal of the gallbladder should be practiced to help minimize the chance of mechanical exfoliation or implantation of malignant cells during LC. In isolated metastatic localization, LC may be curative and provide adequate palliation of symptoms with a short convalescence and a fast recovery.

Metastatic melanoma of the gallbladder: report of two cases and a review of the literature

“…Seelig et al [24] and Tuveri et al [25] both reported a 20-and 60-month survival, respectively, in patients treated with laparoscopic cholecystectomy. This finding is supported by Kohler et al [8] and by Samplaski et al [26] who supported the suitability of laparoscopic cholecystectomy in patients with metastatic melanoma of the gallbladder.…”

“…Of course, a clinical history of cutaneous melanoma is more suggestive of secondary lesions and the immunohistochemical marker HMB45 could rule out the presence of junctional activity, which is typical of the primitive tumor. However, cutaneous melanoma could have a spontaneous regression and junctional activity could be present in advanced metastatic disease as well, or it could be missing in the primitive lesion characterized by a rapid growth which makes diagnosis challenging [8,25].…”

“…However, the main risks related to LC (perforation of the gallbladder and intra-abdominal bile leak and/or port sites) could be prevented with gentle dissection and use of the endobag [20,25].…”

“…This finding is supported by Kohler et al [8] and by Samplaski et al [26] who supported the suitability of laparoscopic cholecystectomy in patients with metastatic melanoma of the gallbladder. Therefore, laparoscopic cholecystectomy (LC) seems to be an adequate treatment for patients with isolated and resectable disease as the vast majority of metastatic melanoma is intraluminal and regional node dissection is not recommended for stage 4 melanoma [2,[25][26][27].…”

Metastasis to the gallbladder: A single-center experience of 20 cases in South Korea

“…In an analysis of 687 necropsies of patients with renal cell carcinoma, four cases had MGBs [3] . However, the data available on MGBs are only from autopsy series of certain malignancies such as melanoma or renal cell carcinoma, or reviews of a certain metastatic carcinoma to the GB such as melanoma [6,7] , or in the form of single case reports of tumors such as melanoma [8][9][10][11] , breast cancer [4] , and hepatocellular carcinoma [5] . Furthermore, there is limited data on the proportion of MGBs among GB malignancies.…”