title: Successful treatment of acute disseminated intravascular coagulation in a patient with metastatic melanoma.
abstract: BACKGROUND
  Acute disseminated intravascular coagulation (DIC) in cancer is rare and often fatal, whereas chronic forms are more frequent.
  
  
  METHODS
  A 37-year-old man with a known history of melanoma excised 6 years ago, presented with abdominal pain, fatigue and epistaxis. A computed tomography scan revealed diffuse metastatic disease of the liver, and laboratory analysis was consistent with accentuated DIC. After chemotherapy with dacarbacine, vinblastine and cisplatine, the acute DIC improved rapidly. After a second cycle, the tumor marker S-100 dropped from 15 to 3.1 microg/l (< 0.15 microg/l), suggesting that the improvement of the DIC was associated with a response to chemotherapy. After 2 cycles of chemotherapy, a palliative right hemihepatectomy was performed followed by 4 additional postoperative chemotherapy cycles. The patient survived 1 more year without relapse of the DIC.
  
  
  CONCLUSIONS
  The cornerstone of managing DIC in cancer consists in treatment of the underlying disease. The rapid control of DIC in our patient can be explained by early diagnosis of the coagulopathy and the fast response of the tumor to the multidrug therapy. Thus, combination chemotherapy of metastatic melanoma is justified if an effective response has to be obtained in a limited time.
authors.affiliation: Department of Oncology/Hematology, St. Gallen, Switzerland. marc.schlaeppi@kssg.ch
authors.forename: Marc Roger
authors.initials: MR
authors.lastname: Schlaeppi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Korte
authors.forename: Roger
authors.initials: R
authors.lastname: von Moos
authors.forename: Thomas
authors.initials: T
authors.lastname: Cerny
authors.forename: Silke
authors.initials: S
authors.lastname: Gillessen
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D012878:Skin Neoplasms / Q000473:pathology; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D003606:Dacarbazine; D002945:Cisplatin