title: Malignant melanoma of the gastro-intestinal tract: a case series.
abstract: BACKGROUND
  Resection of gastrointestinal (GI) metastases of malignant melanoma (MM) offers a significant survival benefit. No adjuvant therapy has been shown to be effective in the treatment of these metastases.
  
  
  METHODS
  All resections of MM affecting the GI tract at a UK University teaching hospital between October 1999 and January 2013 were identified from a pathology database. Demographic, investigative, operative and outcome data were retrieved from hospital records. Survival analysis was performed.
  
  
  RESULTS
  Thirty patients were identified (median age 62.7 years). 3 patients underwent a second operation at a later date to resect further metastases. 6 patients (20.0%) presented with no identifiable cutaneous lesion. The average time to GI metastases was 52.0 months (range 4.9-139.8 months) for those with an identified cutaneous primary (n = 24). Two patients with initial cutaneous lesions with Breslow's thickness <1 mm developed GI metastases. Common presenting symptoms included abdominal pain (n = 8, 27.6%), GI bleeding (n = 5, 17.2%) and symptoms of GI tract obstruction (n = 4, 13.8%). CT scan was the most commonly performed investigation (96.6%). Over half of resections (54.5%, n = 18) included small bowel resection. Mortality at 2 and 5 years was 66.4% and 73.1%. Of the 3 patients who underwent a second resection of GI metastases, one is still alive after 26 months of follow up; 2 patients died after 32.8 and 18.6 months.
  
  
  CONCLUSIONS
  Clinicians should have a low threshold for investigating GI symptoms in patients with a history of malignant melanoma even in the case of early-stage primary disease. Re-resection should be considered in patients presenting with further GI metastases.
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK. Electronic address: kamleshpatel@doctors.org.uk.
authors.forename: K
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: S T
authors.initials: ST
authors.lastname: Ward
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: T
authors.initials: T
authors.lastname: Packer
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.affiliation: Department of Dermatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: J
authors.initials: J
authors.lastname: Marsden
authors.affiliation: Birmingham Skin Centre, City Hospital NHS Trust, Dudley Road, Birmingham, West Midlands B18 7QH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Thomson
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: T
authors.initials: T
authors.lastname: Ismail
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Gastro-intestinal; Melanoma; Metastasis