Primary Small Bowel Melanoma or Small Bowel Metastasis with Vanishing Primary Cutaneous Lesion

Dana Criṣan,Tudor Pop,Constantin Bodolea,Nadim Al Hajjar,Lucreţia Avram,Andreea Ardelean,Sorin Criṣan,Ioana Rusu,Mihaela Coman,Laurenţiu Stoicescu

doi:10.4236/crcm.2022.113010

Dana Criṣan, Tudor Pop + Show 8 more

Open Access

https://doi.org/10.4236/crcm.2022.113010

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Abstract

The small bowel represents one of the main sites for cutaneous melanoma metastasis; however, numerous cases of primary intestinal melanoma have recently been described. In view of this, we present the case of a 39-year-old woman admitted for nausea, heartburn, abdominal pain, change in bowel habits and weight loss. Contrast-enhanced CT revealed a small bowel mass. Surgical resection of a 6 cm ileal tumour with regional mesenteric lymphadenectomy and end-to-end anastomosis was performed. Histopathological findings indicated the presence of an ileal melanoma metastasis. Subsequent dermatological examination identified a cutaneous lesion on the right forearm, however no malignant cells were found at the histopathological exam. Whole body PET CT with FDG identified multiple frontal and parietal lesions. Genetic testing was positive for BRAF gene V600 E mutation. The patient underwent multiple neurosurgical procedures for the resection of cerebral metastases. Palliative external radiation and chemotherapy was also attempted. After approximately 2 years after the diagnosis, the patient died following multiple episodes of intracranial hypertension.

Highlights

Criṣan et al DOIThis type of malignancy is characterised by an elevated affinity for the small bowel as metastasis site, more than half of melanoma patients exhibiting intestinal metastasis at autopsy
Skin melanoma is the most frequent malignancy to develop small bowel metastasis, namely up to one third of small bowel metastasis are due to melanoma [2], followed by breast and pulmonary cancer [3]
A possible explanation for the affinity of melanoma for the small bowel resides in the presence of surface chemokine CCR9 on melanoma cells that binds to the CCL25, found on intestinal cells [4]

Summary

Criṣan et al DOI

This type of malignancy is characterised by an elevated affinity for the small bowel as metastasis site, more than half of melanoma patients exhibiting intestinal metastasis at autopsy. Numerous cases of primary intestinal melanoma have been published, the possibility of melanoma developing directly from the intestinal mucosa represents an ongoing matter of debate, some authors suggesting that other organ involvement is associated with the regression of the primary cutaneous melanoma. Most intestinal melanoma initially present with symptoms of small bowel obstruction. The mean survival of patients with metastatic melanoma amounting to approximately 5 months, possibly improved by surgical tumour resection. The aim of this paper is to provide further insight into this disease and draw attention to the difficulty of differentiating between primary intestinal melanoma and intestinal melanoma metastasis with vanishing primary cutaneous lesion

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