Visceral metastases from malignant melanoma (stage M1c) confer a very poor prognosis, as documented on the most recent revised version of the TNM/AJCC staging system. Emergency surgery for intra-abdominal complications from the disease is rare. We report on our 5-year single institution experience with surgical management of metastatic melanoma to the viscera in the emergent setting. From 2009 to 2013, 14 patients with metastatic melanoma were admitted emergently due to an acute abdomen. Clinical manifestations encompassed intestinal obstruction and bleeding. Surgical procedures involved multiple enterectomies with primary anastomoses in 8 patients, and one patient underwent splenectomy, one adrenalectomy, one right colectomy, one gastric wedge resection, one gastrojejunal anastomosis, and one transanal debulking, respectively. The 30-day mortality was 7 percent. Median follow-up was 14 months. Median overall survival was 14 months. Median disease free survival was 7.5 months. One-year overall survival was 64.2 percent and 2-year overall survival was 14.2 percent. Emergency surgery for metastatic melanoma to the viscera is rare. Elective curative surgery combined with novel cytotoxic systemic therapies is under investigation in an attempt to grant survival benefit in melanoma patients with visceral disease. 1. Introduction Metastatic melanoma is an aggressive disease with dismal prognosis despite novel chemotherapeutic agents. M1c disease is defined as the presence of visceral metastases with elevated lactate dehydrogenase (LDH) level in the absence of pulmonary metastasis and carries a median survival of about 6 to 10 months [1]. Advanced melanoma can disseminate to any organ, with the commonest distant sites of metastasis being the skin, lung, and brain. In cases of visceral involvement, metastatic malignant melanoma most commonly attains the liver and the small bowel. Interestingly, up to 95 percent of patients with metastases to the gastrointestinal tract will not be identified until autopsy [1]. Intra-abdominal dissemination of melanoma can manifest itself with weight loss, vague abdominal pain, and/or anemia. In some cases, patients can present in the emergency setting with bowel intussusception, obstruction, bleeding, or perforation [2]. Although an acute abdominal symptomatology can raise the suspicion of intra-abdominal metastasis in any patient with a history of cutaneous melanoma, diagnosis is definitely made at surgery. We report on our five-year, single-center experience in emergency surgery for M1c melanoma. 2. Case Series Between 2009 and
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