Malignant Melanoma of the Gallbladder: A Report of Two Cases and Review of the Literature

Abstract

Melanoma metastatic to the gallbladder is rare. When present, it is often part of a widespread complex of metastases. Primary gallbladder melanomas are also extremely rare and can sometimes be difficult to distinguish from metastatic lesions. The optimal treatment for malignant melanoma of the gallbladder remains unclear, and prognosis is generally poor. We present here two cases of patients with metastatic lesions to the gallbladder. One patient presented with symptomatic cholelithiasis and was found incidentally to have a metastasis. Another patient had known a metastasis, but underwent curative resection of the only site of disease. We review the published literature for gallbladder melanoma, both primary and metastatic to determine the role of surgery in this disease.

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

“…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].…”

“…Melanoma may arise from any mucosa containing melanocytes that migrate from the neural crest to endodermic tissue during embryogenesis [8,9]. The frequency of this tumor is increasing worldwide: in the last 15 years, the number of cases of melanoma has virtually doubled.…”

“…When symptoms are present, the most common is upper abdominal pain resembling cholecystolithiasis; cases of hemobilia and biliary fistula have also been described [2,8,9,17].…”

“…The conventional diagnostic work-up is based on abdomen ultrasonography, preferably with color-power Doppler, and CT scans that may detect the presence of an intraluminal mass; the fluorodeoxyglucose (FDG) PET/CT is a second-step investigation that could confirm the diagnosis by showing an increased uptake [6,8,9].…”

“…In fact, the metastases to the gastrointestinal tract are likely to occur as a consequence of the spreading of tumor cells shed into the bile [8,9,22].…”