Small intestinal metastasis of cutaneous melanoma in an elderly woman: Survival benefits of surgery and novel targeted therapies - A case report.

INTRODUCTION AND IMPORTANCE

Cutaneous malignant melanoma, originating from melanocytes, is a highly metastatic cancer with an incidence rate of 0.9 per 100,000. The gastrointestinal tract is a common site of metastasis, with the small intestine being particularly affected. The aggressive nature and frequency of this condition emphasize the importance of prompt diagnosis and effective treatment.

CASE PRESENTATION

We report the case of an 82-year-old female with a history of left heel cutaneous melanoma, previously treated with excision and immunotherapy. Within six months of achieving disease-free status, an abdominal mass was detected during routine positron emission tomography-computed tomography. A radiological biopsy confirmed metastatic melanoma. Due to the localized nature of the disease, the patient underwent small bowel resection and was restarted on immunotherapy. Despite these interventions, brain and liver metastases developed within two months, highlighting the rapid progression and poor prognosis associated with this condition.

CLINICAL DISCUSSION

Melanoma frequently metastasizes to the gastrointestinal tract, with the small intestine being the most common site. These metastases present diagnostic challenges due to nonspecific symptoms such as abdominal pain or anemia. Multidisciplinary approaches combining surgical resection and systemic therapies, including immunotherapy and BRAF inhibitors, have dramatically improved survival rates in selected patients, even at advanced stages.

CONCLUSION

This case highlights the survival benefits of surgical resection in elderly patients with intestinal melanoma metastases, particularly when the disease-free interval from primary melanoma excision is under one year. While advancements in targeted therapies have transformed management, surgery remains vital for symptom relief and outcomes.