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Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes

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Abstract

Background and aims

Melanoma incidence has increased worldwide with a concurrent rise in both primary and metastatic melanomas of the gastrointestinal tract.

Materials and methods

This retrospective single-center case series includes patients with histopathology-confirmed primary or metastatic melanoma of the GI tract between 1998 and 2018.

Results

Thirty-four patients were identified for inclusion, of whom 7 were primary and 27 were metastatic cases of gastrointestinal melanoma. For both primary and metastatic cases, the majority of patients presented with frank or occult GI bleeding (57.1% and 70.4%). Primary and metastatic lesions were predominantly diagnosed endoscopically (100% and 63.0%), with 71.4% of primary lesions found at the anorectal junction and 51.9% of metastatic lesions in the small bowel. Endoscopically diagnosed lesions were either polypoid (50%) or a luminal mass (37.5%) in the majority of cases. Common features included: amelanotic (83%), ulcerated (50%), and friable (33.3%). All primary patients were treated with surgical excision or resection. Of the metastatic patients, 56% were resected. The median interval between initial primary and gastrointestinal metastases was 65 months (ranging from 1 month to 24 years). At the time of data analysis, 85.7% of primary and 29.6% of metastatic patients remained alive.

Conclusions

The majority of patients in this series were diagnosed endoscopically while investigating a source of gastrointestinal blood loss. Heightened clinical suspicion and recognition of the endoscopic features of gastrointestinal melanoma during evaluation of GI symptoms in a patient with a personal history of primary melanoma are advised.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386. https://doi.org/10.1002/ijc.29210

    Article  CAS  PubMed  Google Scholar 

  2. McLaughlin CC, Wu XC, Jemal A et al (2005) Incidence of noncutaneous melanomas in the U.S. Cancer 103:1000–1007. https://doi.org/10.1002/cncr.20866

    Article  PubMed  Google Scholar 

  3. Meyers ML, Balch CM (1998) Diagnosis and treatment of metastatic melanoma. In: Balch CM, Houghton AN, Sober AJ, Song SJ (eds) Cutaneous melanoma, 3rd edn. Mo Quality Medical Publishing Inc, St Louis, pp 325–372

    Google Scholar 

  4. Rose DM, Essner R, Hughes TMD et al (2001) Surgical resection for metastatic melanoma to the liver: the john wayne cancer institute and sydney melanoma unit experience. Arch Surg 136(8):950–955. https://doi.org/10.1001/archsurg.136.8.950

    Article  CAS  PubMed  Google Scholar 

  5. Blecker D, Abraham S, Furth EE et al (1999) Melanoma in the gastrointestinal tract. Am J Gastroenterol 94:3427–3433. https://doi.org/10.1111/j.1572-0241.1999.01604.x

    Article  CAS  PubMed  Google Scholar 

  6. Erdei E, Torres SM (2010) A new understanding in the epidemiology of melanoma. Expert Rev Anticancer Ther 10:1811–1823. https://doi.org/10.1586/era.10.170

    Article  PubMed  PubMed Central  Google Scholar 

  7. Elsayed AM, Albahra M, Nzeako UC, Sobin LH (1996) Malignant melanomas in the small intestine: a study of 103 patients. Am J Gastroenterol 91:1001–1006

    CAS  PubMed  Google Scholar 

  8. Hadjinicolaou AV, Hadjittofi C, Athanasopoulos PG et al (2016) Primary small bowel melanomas: fact or myth? Ann Transl Med 4:113. https://doi.org/10.21037/atm.2016.03.29

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gilg MM, Gröchenig HP, Schlemmer A et al (2018) Secondary tumors of the GI tract: origin, histology, and endoscopic findings. Gastrointest Endosc 88(151–8):e1. https://doi.org/10.1016/j.gie.2018.02.019

    Article  Google Scholar 

  10. Berger AC, Buell JF, Venzon D et al (1999) Management of symptomatic malignant melanoma of the gastrointestinal tract. Ann Surg Oncol 6:155–160

    Article  CAS  PubMed  Google Scholar 

  11. Mihajlovic M, Vlajkovic S, Jovanovic P, Stefanovic V (2012) Primary mucosal melanomas: a comprehensive review. Int J Clin Exp Pathol 5:739–753

    PubMed  PubMed Central  Google Scholar 

  12. Schadendorf D, Hodi FS, Robert C et al (2015) Pooled analysis of long-term survival data from phase II and phase III trials of ipilimumab in unresectable or metastatic melanoma. J Clin Oncol 33:1889–1894. https://doi.org/10.1200/jco.2014.56.2736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30. https://doi.org/10.3322/caac.21442

    Article  PubMed  Google Scholar 

  14. Guy GP Jr, Thomas CC, Thompson T et al (2015) Vital signs: melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep 64:591–596

    PubMed  PubMed Central  Google Scholar 

  15. Holman DM, Freeman MB, Shoemaker ML (2018) Trends in melanoma incidence among non-hispanic whites in the United States, 2005 to 2014. JAMA Dermatol 154:361–362. https://doi.org/10.1001/jamadermatol.2017.5541

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917. https://doi.org/10.1002/ijc.25516

    Article  CAS  PubMed  Google Scholar 

  17. Aitken JF, Youlden DR, Baade PD et al (2018) Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995–2014. Int J Cancer 142:1528–1535. https://doi.org/10.1002/ijc.31141

    Article  CAS  PubMed  Google Scholar 

  18. Patel K, Ward ST, Packer T et al (2014) Malignant melanoma of the gastro-intestinal tract: a case series. Int J Surg 12:523–527. https://doi.org/10.1016/j.ijsu.2014.02.011

    Article  CAS  PubMed  Google Scholar 

  19. Ollila DW, Essner R, Wanek LA, Morton DL (1996) Surgical resection for melanoma metastatic to the gastrointestinal tract. Arch Surg 131:975–980

    Article  CAS  PubMed  Google Scholar 

  20. Kim GH, Ahn JY, Jung HY et al (2015) Clinical and endoscopic features of metastatic tumors in the stomach. Gut Liver 9:615–622. https://doi.org/10.5009/gnl14032

    Article  PubMed  Google Scholar 

  21. Taal BG, Westerman H, Boot H, Rankin EM (1999) Clinical and endoscopic features of melanoma metastases in the upper GI tract. Gastrointest Endosc 50:261–263. https://doi.org/10.1016/S0016-5107(99)70236-1

    Article  CAS  PubMed  Google Scholar 

  22. Weinstock MA (1993) Epidemiology and prognosis of anorectal melanoma. Gastroenterology 104:174–178. https://doi.org/10.1016/0016-5085(93)90849-8

    Article  CAS  PubMed  Google Scholar 

  23. Iddings DM, Fleisig AJ, Chen SL et al (2010) Practice patterns and outcomes for anorectal melanoma in the USA, reviewing three decades of treatment: is more extensive surgical resection beneficial in all patients? Ann Surg Oncol 17:40–44. https://doi.org/10.1245/s10434-009-0705-0

    Article  PubMed  Google Scholar 

  24. Kirchoff DD, Deutsch GB, Foshag LJ, Lee JH, Sim MS, Faries MB (2016) Evolving therapeutic strategies in mucosal melanoma have not improved survival over five decades. Am Surg 82:1–5

    Article  PubMed  PubMed Central  Google Scholar 

  25. Agrawal S, Yao TJ, Coit DG (1999) Surgery for melanoma metastatic to the gastrointestinal tract. Ann Surg Oncol 6:336–344

    Article  CAS  PubMed  Google Scholar 

  26. Caputy GG, Donohue JH, Goellner JR, Weaver AL (1991) Metastatic melanoma of the gastrointestinal tract: results of surgical management. Arch Surg 126:1353–1358. https://doi.org/10.1001/archsurg.1991.01410350043007

    Article  CAS  PubMed  Google Scholar 

  27. Khalil DN, Carvajal RD (2014) Treatments for noncutaneous melanoma. Hematol Oncol Clin North Am 28:507–521. https://doi.org/10.1016/j.hoc.2014.02.006

    Article  PubMed  Google Scholar 

  28. Myint ZW, Goel G (2017) Role of modern immunotherapy in gastrointestinal malignancies: a review of current clinical progress. J Hematol Oncol 10:86. https://doi.org/10.1186/s13045-017-0454-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hanna TP, Nguyen P et al (2018) A population-based study of survival impact of new targeted and immune-based therapies for metastatic or unresectable melanoma. Clin Oncol 30(10):609–617

    Article  CAS  Google Scholar 

  30. Patel JK, Didolkar MS, Pickren JW, Moore RH (1978) Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 135:807–810. https://doi.org/10.1016/0002-9610(78)90171-X

    Article  CAS  PubMed  Google Scholar 

  31. Amar A, Jougon J, Edouard A et al (1992) Primary malignant melanoma of the small intestine. Gastroenterol Clin Biol 16:365–367

    CAS  PubMed  Google Scholar 

  32. Tingsgaard JK, Henriksen A et al (2018) Primary and secondary mucosal melanoma of the small intestine—a clinical, pathological, and genetic nationwide survey of Danish patients between 1980 and 2014. APMIS 126(9):739–745. https://doi.org/10.1111/apm.12883

    Article  PubMed  Google Scholar 

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Funding

This study did not receive any funding from any sources

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Authors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA

    Danielle La Selva, Richard A. Kozarek, Russell K. Dorer, Flavio G. Rocha & Michael Gluck

  2. Division of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, 98101, USA

    Michael Gluck

Authors
  1. Danielle La Selva
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  2. Richard A. Kozarek
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  3. Russell K. Dorer
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  4. Flavio G. Rocha
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  5. Michael Gluck
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Correspondence to Michael Gluck.

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Disclosures

Danielle La Selva, Richard A. Kozarek, Russell K. Dorer, Flavio G. Rocha, and Michael Gluck have no conflicts of interest or financial ties relevant to this study to disclose.

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La Selva, D., Kozarek, R.A., Dorer, R.K. et al. Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes. Surg Endosc 34, 4456–4462 (2020). https://doi.org/10.1007/s00464-019-07225-8

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  • DOI: https://doi.org/10.1007/s00464-019-07225-8

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