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Gastrointestinal malignant melanoma
Author(s) -
Woollons Arjida,
Derrick Elizabeth K.,
Price Margaret L.,
Darley Charles R.
Publication year - 1997
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/j.1365-4362.1997.tb03072.x
Subject(s) - medicine , organomegaly , iliac fossa , barium enema , abdominal pain , abdomen , surgery , physical examination , colonoscopy , radiology , colorectal cancer , cancer , polyneuropathy
Case 1 A 69‐year‐old man was referred for investigation of abdominal pain, progressive weight loss, and iron deficiency anaemia. Faecal occult bloods were positive and there was no medical history of note. Physical examination revealed a firm mobile mass in the right iliac fossa. There was no organomegaly or lymphadenopathy, the retinae were clear, and no cutaneous lesions were evident. Abdominal ultrasound scan, small bowel enema, and colonoscopy were all normal, as were renal and liver function tests. Abdominal CT showed a soft tissue mass within the right iliac fossa. The patient underwent a right hemicolectomy and a large 10 × 10 cm caecal tumor was removed which was infiltrating the surrounding small bowel. Histology showed this to be metastatic malignant melanoma, confirmed by morphologic and immunochemical studies, and the tumor infiltrated the submucosa. The tumor cells stained positively with S100 protein. Resection was complete (Fig. 1a). On close enquiry postoperatively the patient recalled a mole on his back that had disappeared spontaneously 20 years previously. Five years after surgery he remained in good health with no signs of recurrence and no cutaneous lesions. Case 2 A 60‐year‐old man was referred with a 3‐month history of nausea, lower abdominal pain, and weight loss. The medical history was unremarkable. Clinical examination showed a mass in the right iliac fossa, but no lymphadenopathy or organomegaly. Sigmoidoscopy to 15 cm was normal, and a barium enema showed diverticular disease only. Ultrasound examination of the abdomen was normal. Gastroscopy showed a small polyp in the body of the stomach; biopsies showed this to be malignant melanoma. One week later the patient presented as an emergency with an acute abdomen. At laparotomy an intestinal perforation was found with nodular metastases in the stomach, duodenum, and small bowel. An amelanotic nodule on his right thigh was biopsied at the same time, and histology of these lesions showed malignant melanoma. The stomach lesions showed extensive infiltration of the antrum and proximal duodenum by solid sheets of malignant melanocytes, invading throughout the full thickness of the muscularis propria (Fig. 1b). A Polya gastrectomy was performed a month later, by which time the patient had developed further cutaneous deposits of melanoma. Two months after discharge he was readmitted with pancreatic spread and obstructive jaundice which was relieved when a stent was inserted. He was transferred to the local hospice for terminal care, and died shortly afterwards.