Malignant Melanoma of the Gastrointestinal Tract: Symptoms, Diagnosis, and Current Treatment Options

Abstract

Malignant melanoma (MM) has become the fifth most frequent cancer in the UK. It is the most common carcinoma to metastasize to the gastrointestinal (GI) tract. MM particularly has an affinity to spread to the small bowel, which is followed by the involvement of the stomach and large intestine. Excellent endoscopic options including video capsule endoscopy and enteroscopy are available for a precise diagnosis of GI involvement by a metastatic MM. The complete surgical resection of GI metastatic MM in carefully selected patients not only provides symptom control, but has also been associated with an increase in overall survival. The approval of BRAF-targeted therapies and immune checkpoint inhibitors has transformed therapeutic approaches for patients with metastatic MM over the past decade. Currently, the overall survival of patients with advanced metastatic MM who have been treated with a combination of immunotherapeutic agents reaches 52% at five years. The role of surgery for patients with the metastatic involvement of the GI tract with MM is evolving in the era of effective systemic treatments.

Multiple gastrointestinal melanoma causing small bowel intussusception

“…Early detection and surgical resection still provide the best long-term disease-free survival [7]. In the era of advancement of targeted therapy and immunotherapy, the treatment of metastatic melanoma has been revolutionized with immune checkpoint inhibitors and targeted BRAF/MEK inhibitors [9]. The landmark trial CheckMate-067 explore the efficacy of ipilimumab/nivolumab combination compared with monotherapy for advanced melanoma and concluded the superior results in the combination group in improving the median overall survival from 37 months to more than 60 months [9].…”

A Rare Form of Metastatic Melanoma in an HIV-Infected Patient – A Diagnosis to Remember

“…It has been estimated that the incidence of melanoma in HIV-infected people is 2.6-fold higher than in uninfected ones [ 2 ], and malignant melanoma is the most common carcinoma to metastasize to the GI tract, followed by breast and lung cancer [ 1 ]. One of the most common signs of colonic metastasis in patients with melanoma is intestinal bleeding [ 3 ] as was the case with our patient.…”

“…One of the most common signs of colonic metastasis in patients with melanoma is intestinal bleeding [ 3 ] as was the case with our patient. Nevertheless, recent studies show that up to 31% of stage III and stage IV patients could have asymptomatic GI metastasis [ 1 ].…”

“…Malignant melanoma (MM), an epithelial cancer, arises from melanocytes, which can be found in a variety of tissue types. Despite being the rarest of skin cancers, it remains the deadliest and most likely to spread [ 1 ]. In human immunodeficiency virus (HIV)-infected people, melanoma has generally a more aggressive behavior and lower survival compared to uninfected people [ 2 ].…”

“…Although MM metastasizes frequently to the gastrointestinal (GI) tract, secondary colonic disease is rare [ 3 ]. These metastases often present with nonspecific symptoms such as fatigue, weight loss, obstruction, and malabsorption [ 1 , 4 ]. Symptomatic GI involvement is found in less than 5% of melanoma cases [ 1 , 4 ]; however, it has been demonstrated in up to 60% at post-mortem [ 1 ].…”