Resection of metastases to the alimentary tract from malignant melanoma

Metastases to the celio-mesenteric organs from malignant melanoma are studied retrospectively in 22 autopsied cases and in seven surgically treated patients. Metastatic disease to one or more celio-mesenteric organs was found in 86.3% of postmortem examinations: the liver was the most frequently involved organ, followed by the pancreas, peritoneum, small bowel, biliary tract spleen, colon and stomach, in that order. Surgery only resulted in long-term asymptomatic survival in those patients with a long relapse-free interval and a single metastasis. It is concluded that, apart from cases with intestinal obstruction or massive GI bleeding, resection should be reserved for patients with a relapse-free interval of at least 15 months and with a single "alimentary" metastasis. It is suggested that diagnosis of systemic spread at the asymptomatic stage would improve prognosis of stage IV malignant melanoma.