Management of intussusception in patients with melanoma

Abstract

Background Increased cross‐sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods We performed a multi‐institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre‐emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre‐emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

Multiple gastrointestinal melanoma causing small bowel intussusception

“…Small bowel melanoma is aggressive, and with metastasis, its prognosis is worse than the cutaneous or extraintestinal melanomas. The medial survival time reported is about 6 months with 5 years overall survival of less than 10% [5,6]. The aggressive tumor biology with poor prognosis making many reserved for the benefit from operative exploration in the asymptomatic patient.…”

“…The aggressive tumor biology with poor prognosis making many reserved for the benefit from operative exploration in the asymptomatic patient. It has been reported that the incidental intussusception often resolves spontaneously on follow-up imaging, and these patients can be managed expectantly [5]. However, follow-up on a case series demonstrated that 50% would eventually require complicated intussusception surgery.…”

“…The clinical presentation was not specific, vague abdominal pain, unexplained weight loss, anemia, and GI bleeding, leading to late diagnosis. Intussusception from melanoma as the pathological lead point poses a challenge to diagnose, especially when it is an uncomplicated, asymptomatic case [5]. The inciden-tal finding on imaging would often require surgical resection to confirm the diagnosis of intestinal melanoma [1,5].…”

“…Intussusception from melanoma as the pathological lead point poses a challenge to diagnose, especially when it is an uncomplicated, asymptomatic case [5]. The inciden-tal finding on imaging would often require surgical resection to confirm the diagnosis of intestinal melanoma [1,5]. GI melanoma, likewise any mucosal melanoma, are more aggressive than cutaneous melanoma with a median survival of about 4 to 6 months and a 5-year overall survival rate of less than 10% [6].…”

Primary Splenic Melanoma Associated with Small Intestinal Serosal Implants Causing Intussusception - A Case Report

“…The patient may pass asymptomatic or he may be presented with symptoms and signs of intestinal obstruction. Resection of the involved segment is the best-suggested management approach aiming at least for symptomatic relief & improvement of the quality of life (20,21).…”