Metastatic melanoma of the gallbladder: An unusual clinical presentation of acute cholecystitis

Abstract

Metastatic disease from cutaneous melanoma can affect all organs of the body, and varies in its biological behavior and clinical presentation. We present the case of a 58-year-old man who arrived at our clinic with acute abdominal pain, which, after investigation, was diagnosed as acute cholecystitis. The patient underwent laparotomy and cholecystectomy. Two years ago, he underwent surgical removal of a primary cutaneous melanoma on his right upper back. Pathological examination revealed the presence of malignant melanoma with a metastatic lesion of the gallbladder.

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

“…Distant metastatic sites include skin and soft tissues, lung, liver, brain and gastrointestinal tract [2][3][4][5]14]. Among the gastrointestinal metastases, the most common sites are small bowel (35-67 %), colon (9-15 %) and stomach (5-7 %) [6].…”

“…Conversely, the long-term survival rate of metastatic disease (stage 4) is very low with a median overall survival rate of 33 % after 1 year and 15 % after 5 years [15]. For patients with stage 4 disease, the median survival rate reported after surgery is 6-10 months and a long-term disease-free survival rate may be achieved only in a small percentage of patients [2,6].…”

“…At autopsy, the gallbladder metastases occur in up to 20 % of patients who died of malignant melanoma, but are rarely reported during the patients' lifetime because they are mostly symptom free [2,3,6]. 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].…”

“…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].…”

“…Although it accounts for\5 % of all skin cancers, melanoma is responsible for the majority of the skin-related deaths, due to its high tendency to metastasize. The most common sites of distant metastases are soft tissues (50-75 %), lung (70-87 %), liver (54-77 %), skin (50-75 %) and brain [2][3][4][5]. A small percentage of patients (from 2 to 4 %) affected by cutaneous melanoma are diagnosed with gastrointestinal metastases and the most common sites are small bowel, colon and stomach, with a low overall survival rate [6].…”