Liang Kelly V, Sanderson Schuyler O, Nowakowski Grzegorz S, Arora Amindra S
Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Mayo Clin Proc. 2006 Apr;81(4):511-6. doi: 10.4065/81.4.511.
Malignant melanoma is one of the most common malignancies to metastasize to the gastrointestinal (GI) tract. Metastases to the GI tract can present at the time of primary diagnosis or decades later as the first sign of recurrence. Symptoms may include abdominal pain, dysphagia, small bowel obstruction, hematemesis, and melena. We report 2 cases of malignant melanoma metastatic to the GI tract, followed by a review of the literature. The first case is a 72-year-old man who underwent resection of superficial spreading melanoma on his back 13 years previously who presented with dysphagia. A biopsy specimen of a mucosal fold in a gastric fundus noted during endoscopy was taken and revealed metastatic malignant melanoma, which was resected 1 month later. Three weeks later, the patient was found to have an ulcerated jejunal metastatic melanoma mass, which was also resected. The second case is a 63-year-old man with an ocular melanoma involving the chorold of the left eye that had been diagnosed 4 years previously, which had been excised several times, who presented with anorexia, dizziness, and fatigue. He was found to have cerebellar and stomach metastases. He underwent adjuvant radiation therapy, chemotherapy, and surgical resection of the gastric melanoma metastasis. In patients with a history of melanoma, a high index of suspicion for metastasis must be maintained if they present with seemingly unrelated symptoms. Diagnosis requires careful inspection of the mucosa for metastatic lesions and biopsy with special immunohistochemical stains. Management may include surgical resection, chemotherapy, immunotherapy, observation, or enrollment in clinical trials. Prognosis is poor, with a median survival of 4 to 6 months.
恶性黑色素瘤是最常见的转移至胃肠道（GI）的恶性肿瘤之一。胃肠道转移可在初次诊断时出现，或在数十年后作为复发的首发症状出现。症状可能包括腹痛、吞咽困难、小肠梗阻、呕血和黑便。我们报告2例胃肠道转移的恶性黑色素瘤病例，随后对文献进行综述。第一例是一名72岁男性，13年前因背部浅表扩散性黑色素瘤接受手术切除，现出现吞咽困难。在内镜检查时对胃底黏膜皱襞取活检标本，结果显示为转移性恶性黑色素瘤，1个月后进行了切除。三周后，发现患者有一个空肠转移性黑色素瘤溃疡肿块，也进行了切除。第二例是一名63岁男性，4年前被诊断患有累及左眼脉络膜的眼黑色素瘤，已多次切除，现出现厌食、头晕和疲劳。发现他有小脑和胃转移。他接受了辅助放疗、化疗以及胃黑色素瘤转移灶的手术切除。对于有黑色素瘤病史的患者，如果出现看似不相关的症状，必须高度怀疑有转移。诊断需要仔细检查黏膜有无转移病变，并通过特殊免疫组化染色进行活检。治疗可能包括手术切除、化疗、免疫治疗、观察或参加临床试验。预后较差，中位生存期为4至6个月。
