The small intestine is sometimes metastasized by malignant melanoma. While small intestinal involvement is asymptomatic or usually nonspecific, intussusception causing intestinal obstruction is very rare. Herein we report the case of a 68-year-old man with small bowel intussusception due to metastatic malignant melanoma. Although he has been comprehensively treated with surgery, radiation, and immunotherapies, the disease rapidly progressed and consequently severe life-threatening intussusception developed on the small bowel. Because surgical resection of the obstructive melanoma lesions was successful, his quality of life was dramatically improved followed by the resumption of treatment with anti-PD-1. Several effective treatments for metastatic melanoma, including immune checkpoint inhibitors and targeted therapy, have been developed within the past decade. However, given the present case, surgical approaches to symptomatic metastatic melanoma lesions should still be considered as a treatment option for improving not only patients’ critical condition but also their survival.
References
[1]
Lens, M., Bataille, V. and Krivokapic, Z. (2009) Melanoma of the Small Intestine. The Lancet Oncology, 10, 516-521. https://doi.org/10.1016/s1470-2045(09)70036-1
[2]
Kotteas, E.A., Adamopoulos, A., Drogitis, P.D., Zalonis, A., Giannopoulos, K.V., Karapanagiotou, E.M., Saif, M.W. and Syrigos, K.N. (2009) Gastrointestinal Bleeding as Initial Presentation of Melanoma of Unknown Primary Origin: Report of a Case and Review of the Literature. In Vivo, 23, 487-490.
[3]
López, R., Santomé, P., Porto, E., Moreiras, M., Gómez, C., Villanueva, J., Canosa, M., Veiga, O. and Gutiérrez, A. (2011) Intestinal Perforation Due to Cutaneous Malignant Melanomametastatic Implants. Revista Española de Enfermidades Digestivas, 103, 386-388. https://doi.org/10.4321/s1130-01082011000700014
[4]
Suarez, A., Ganfornina, F., Ruiz, J. and Romero, F. (2008) Intususcepción yeyunal por metástases de melanoma cutaneo. Cirugía Española, 84, 165-175. https://doi.org/10.1016/s0009-739x(08)72165-1
[5]
Vaz, P., Usurelu, S., Monteiro, A., Correia, S., Gouveia, A. and Loureiro, A. (2011) Metástase de Melanoma Maligno do Intestino Delgado-Uma Rara Causa de Hemorragia Digestiva Baixa. Acta Médica Portuguesa, 24, 179-182.
[6]
Patel, K., Ward, S.T., Packer, T., Brown, S., Marsden, J., Thomson, M. and Ismail, T. (2014) Malignant Melanoma of the Gastro-Intestinal Tract: A Case Series. International Journal of Surgery, 12, 523-527. https://doi.org/10.1016/j.ijsu.2014.02.011
[7]
Cera, S.M. (2008) Intestinal Intussusception. Clinics in Colon and Rectal Surgery, 21, 106-113. https://doi.org/10.1055/s-2008-1075859
[8]
Marsicovetere, P., Ivatury, S.J., White, B. and Holubar, S.D. (2017) Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Clinics in Colon and Rectal Surgery, 30, 30-39. https://doi.org/10.1055/s-0036-1593429
[9]
Agha, F.P. (1986) Intussusception in Adults. American Journal of Roentgenology, 146, 527-531.
[10]
Sandrasegaran, K., Kopecky, K.K., Rajesh, A. and Lappas, J. (2004) Proximal Small Bowel Intussusceptions in Adults: CT Appearance and Clinical Significance. Abdom Imaging, 29, 653-657. https://doi.org/10.1007/s00261-003-0165-0
[11]
Marcoval, J., Ferreres, J.R., Martín, C., Gómez, S., Penín, R.M., Ochoa de Olza, M. and Fabra, á. (2013) Patterns of Visceral Metastasis in Cutaneous Melanoma: A Descriptive Study. Actas Dermo-Sifiliográficas, 104, 593-597. https://doi.org/10.1016/j.ad.2012.12.012
[12]
Byrne, E.H. and Fisher, D.E. (2017) Immune and Molecular Correlates in Melanoma Treated with Immune Checkpoint Blockade. Cancer, 123, 2143-2153. https://doi.org/10.1002/cncr.30444
[13]
Namikawa, K. and Yamazaki, N. (2019) Targeted Therapy and Immunotherapy for Melanoma in Japan. Current Treatment Options in Oncology, 20, 7. https://doi.org/10.1007/s11864-019-0607-8
