ENDOSCOPIC MUCOSAL RESECTION OF METASTATIC GASTRIC MALIGNANT MELANOMA

Аннотация

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Background. Gastrointestinal malignant melanoma is a rarely observed condition. There is no gold standard of metastatic melanoma treatment. By patients with primary melanoma, surgical excision is preferred. Aim. Those with malignant melanoma, metastasizing into the gastrointestinal mucosa, can benefit from complete endoscopic resection. Material and Methods. A 57-year-old man had a cutaneous femoral melanoma excised in 2008. Three years later he underwent subtotal pancreatic resection and splenectomy for a pancreatic tail neuroendocrine tumor. In 2013 a metastasis of the melanoma into the lower third of the gastric mucosa was discovered, the complete endoscopic mucosal resection was performed. In 2015 the neoplasma metastasized into the soft tissues of the back. Results and Discussion. The recurrence-free period after the endoscopic mucosal resection for metastatic malignant gastric melanoma lasted more than 2 years (27-29 months). For patients with metastatic melanoma surgery remains the method of choice combined with neoadjuvant therapy, or the salvage treatment. Endoscopic resection offers an effective treatment of mucosal malignant tumors. Currently complete surgical resection with intact margins is the first-line treatment of malignant melanoma in patients with one or few solitary metastases. In some studies of sequential complete resections for recurrences the 5-year survival was about 19%. Complete resection shows much better results than the incomplete one (a 75 vs 25% 1-year survival). Conclusions. Complete endoscopic mucosal resection can be an effective minimally invasive method of metastatic malignant melanoma treatment in the presence of solitary metachronous metastases into mucosa.