Metastatic Malignant Melanoma of the Gastrointestinal Tract

Abstract

Malignant melanoma is one of the most common malignancies to metastasize to the gastrointestinal (GI) tract. Metastases to the GI tract can present at the time of primary diagnosis or decades later as the first sign of recurrence. Symptoms may include abdominal pain, dysphagia, small bowel obstruction, hematemesis, and melena. We report 2 cases of malignant melanoma metastatic to the GI tract, followed by a review of the literature. The first case is a 72-year-old man who underwent resection of superficial spreading melanoma on his back 13 years previously who presented with dysphagia. A biopsy specimen of a mucosal fold in a gastric fundus noted during endoscopy was taken and revealed metastatic malignant melanoma, which was resected 1 month later. Three weeks later, the patient was found to have an ulcerated jejunal metastatic melanoma mass, which was also resected. The second case is a 63-year-old man with an ocular melanoma involving the chorold of the left eye that had been diagnosed 4 years previously, which had been excised several times, who presented with anorexia, dizziness, and fatigue. He was found to have cerebellar and stomach metastases. He underwent adjuvant radiation therapy, chemotherapy, and surgical resection of the gastric melanoma metastasis. In patients with a history of melanoma, a high index of suspicion for metastasis must be maintained if they present with seemingly unrelated symptoms. Diagnosis requires careful inspection of the mucosa for metastatic lesions and biopsy with special immunohistochemical stains. Management may include surgical resection, chemotherapy, immunotherapy, observation, or enrollment in clinical trials. Prognosis is poor, with a median survival of 4 to 6 months.

85-Year-Old Male with New Onset Melena

“…In a similar series from Memorial Sloan Kettering in New York, they found that the incidence of gastrointestinal metastasis was small bowel (58%), colon (22%), and rectum (5%) [9]. Symptoms of metastasis can vary but most commonly include abdominal pain, bowel obstruction, perforation, and melana [10].…”

Metastatic melanoma of the stomach

“…Unfortunately, most patients subjected to curative resection experience relapse of the disease. There have been attempts to associate other adjuvant therapies such as immunotherapy and anti-angiogenesis agents in order to prevent the recurrence, but randomized studies have shown no benefits in relation to the survival in the case of immunotherapy 9 .The approach with anti-angiogenesis agents is still under study. In the case reported herein, despite the presence of metastasis of more than one site (TGI and subcutaneous tissue) the resection of the lesions was curative and even without the administration of adjuvant therapy, the patient has remained free of signs of relapse so far.…”

“…The exam of choice for this scanning is the PET-SCAN 4 . Other exams such as high and low digestive endoscopy and CT can be carried out 9 .…”

More than Meets the Eye: Metastatic Uveal Melanoma

“…In the U.S., the incidence of uveal melanoma is 4.3 cases per million people; 3 the average age at diagnosis is 60 years. 4 Once metastasis occurs, survival is under one year, 5 and no cure exists. Our patient died the following week on home hospice.…”