title: Two cases of melanomas paradoxically metastasizing to the intestinal tract during nivolumab therapy.
abstract: We report two cases of melanomas in patients who developed intestinal metastasis despite other metastatic sites responding to nivolumab and despite the patients having favorable findings such as vitiligo and normal lactate dehydrogenase. The first case is an 85-year-old man who had been administrated nivolumab for lung/cutaneous metastases. After 22 courses of nivolumab therapy, fever and anorexia had appeared and his bodyweight had decreased. An intussusception on the ileocecal valve was revealed by computed tomography, and emergency surgery revealed metastatic lesions on the colon. The second case is an 87-year-old woman treated with nivolumab for lymph node metastases. After 10 courses, laboratory tests had revealed anemia and positive fecal occult blood. Her bodyweight had decreased. Capsule endoscopy showed scattered tumors and clots, indicating metastases of melanoma. The frequency of symptomatic intestinal metastasis of melanoma is very low. Further, intestinal metastasis of melanoma is difficult to detect through routine examinations. Our cases suggest that fecal occult blood test and decreased bodyweight are indications of intestinal metastases.
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Hajime
authors.identifier: http://orcid.org/0000-0002-0802-1864
authors.initials: H
authors.lastname: Miyazawa
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Teruki
authors.initials: T
authors.lastname: Yanagi
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Imafuku
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kitamura
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Dermatology, Asahikawa Medical University, Asahikawa.
authors.forename: Jiro
authors.initials: J
authors.lastname: Uehara
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Nobuki
authors.initials: N
authors.lastname: Ichikawa
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawamura
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.affiliation: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D003113:Colonoscopy; D003606:Dacarbazine / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007080:Ileocecal Valve / Q000000981:diagnostic imaging; D007443:Intussusception / Q000000981:diagnostic imaging / Q000209:etiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D000077594:Nivolumab; D009780:Occult Blood; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077594:Nivolumab; D003606:Dacarbazine; D002097:C-Reactive Protein
keywords: fecal occult blood test; intestinal metastasis; malignant melanoma; nivolumab; weight loss