Metastatic melanoma of the gastrointestinal tract: a review of the literature.

Malignant melanoma metastases to the GIT are not uncommon, and often the diagnosis is delayed. Within the GIT, the small bowel is most frequently involved, followed by the stomach, large bowel, and esophagus. Patients with acute complications such as bleeding, perforation, intussusception, and obstruction require urgent surgical intervention. The diagnosis of metastatic melanoma is pathologically confirmed at surgical exploration in 80% of patients, by endoscopic procedures in 15%, and percutaneous biopsy in 5%. Small or large bowel resection for hemorrhage or obstruction provides symptomatic relief in 79-92% of patients with a postoperative mortality rate of 5%. Reported 1- and 5-year survival rates are 44% and 9-19%, respectively. Because of the acceptable morbidity in select symptomatic patients, surgical palliation should be undertaken when the quality of life may be improved. Malignant metastatic melanoma involving the GIT has a dismal prognosis. The symptoms are commonly nonspecific and not recognized antemortem. Gut metastases signify an advanced stage of disease. Chemotherapy and immunotherapy have been ineffective in prolonging survival for these patients. For patients with general good health and symptomatic metastases, their disease can be excised with limited morbidity and mortality while providing effective and lasting palliation. Because of this, surgical resection is warranted in many patients with symptomatic gastrointestinal metastases from melanoma.