Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes
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and Other Interventional Techniques
Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes Danielle La Selva1 · Richard A. Kozarek1 · Russell K. Dorer1 · Flavio G. Rocha1 · Michael Gluck1,2 Received: 29 March 2019 / Accepted: 4 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
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. Keywords Melanoma · Endoscopy · GI Bleeding · Anorectal · Anemia Melanoma incidence has increased worldwide over the past two decades [1, 2]. Melanomas can involve the digestive system, typically presenting as metastases to the liver [3, 4]. Less common are melanomas, both primary and metastatic, in the luminal gastrointestinal (GI) tract. Primary GI melanoma is believed to arise anywhere in the GI tract where melanocytes are present, but they are predominantly diagnosed in the rectum and anus [5, 6]. Metastatic lesions typically originate from a primary cutaneous or ocular lesion, and the majority metastasize to the small bowel [7]. * Michael Gluck [email protected] 1
Digestive Disease Institute, Virginia Mason Medical Center, C3‑GAS, 1100 Ninth Avenue, Seattle, WA, USA
Division of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, C3‑GAS, 1100 Ninth Avenue, Seattle, WA 98101, USA
2
Melanoma remains one
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