SURGICAL RESECTION OF INTESTINAL METASTASIS FROM SCAPULAR CUTANEOUS MELANOMA

Case Presentation: A 64-year-old female patient, with a history of cutaneous melanoma (Breslows depth 7.2 mm) in the scapular region 6 years ago, presented with fatigue, dyspnea, and chronic iron deficiency anemia for which she had been treated with iron supplementation and blood transfusion. Workup tests included colonoscopy and scintigraphy with 99m-technetium marked erythrocytes, which were rather inconclusive. Further investigation with PET/CT evidenced lesions in the proximal jejunum and terminal ileum, associated with perilesional fat stranding. Double balloon enteroscopy-guided biopsy revealed dark-colored ulcerated ileal lesion, and biopsy findings confirmed metastatic melanoma implantation. Segmental enterectomy was performed for both lesions, and tumor histopathology exhibited two ulcerated lesions, both infiltrating the mucosa and the muscular layer, presenting with peritumoral melanophages in the serosa layer, compatible with the diagnosis of gastrointestinal metastatic melanoma. Discussion: Even though gastrointestinal (GI) tract metastases are rare, cutaneous malignant melanoma (MM) figures among the main primary tumors that metastasize to the GI tract due to its characteristic organotropism and high potential of dissemination. MM metastases are mostly found in the small bowel, presenting with high morbidity and elevated mortality when left untreated due to several complications such as bleeding, bowel obstruction, perforation, or fistula, even when the lesion is still small-sized. Final comments: Surgical resection is a promising option for both locally curative therapy and palliative morbidity and mortality reduction. The optimal investigation for GI tract MM metastases includes positron emission tomography/computed tomography (PET/CT) assessment due to its high sensitivity, which overcomes the limitations of purely morphology-based imaging given that small bowel endoscopic investigation is relatively limited.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019