Solitary metastasis from melanoma causing bowel perforation

Skin melanoma can metastasize to any organ or tissue. The median survival in patient with intestinal metastases is inferior to 7 months compared to other sites metastasis. A wide intestinal resection including the resection of the mesentery with lymph nodes remains the main treatment due to the low morbidity and mortality rate it is also associated with.

We took under analysis a recent case of acute abdomen for small bowel perforation from intestinal metastases in a patient with metastatic melanoma who was under treatment with Pemrolizumab. A bowel resection was performed and no other lesions were found in the abdominal examination. However, the chemotherapy was stopped due to the advanced age of the patient, presence of brain metastases that worsening his performance status and the bowel involvement.

Preoperative diagnoses of metastatic or small intestine melanoma tend to often be difficult to perform. Before considering a possible elective surgery, in case of non-urgent symptoms, it is important to value first intestinal or extraintestinal spread. The previous report of bowel perforation from melanoma metastases showed an intraoperative finding of multiple widespread brown lesions. There are not reports about the possible involvement of Pembrolizumab in bowel perforation, which leads to the conclusion that it was probably the ingrown of the metastasis to cause it.

The treatment of metastatic melanoma includes chemotherapy, immunotherapy and target-therapy. It will be useful to do a multicenter study on the survival after complete resection to better define the surgical indication for the treatment of the metastatic disease.

Intestinal perforation, Melanoma, Metastasis.