This document discusses the surgical approach to intra-abdominal metastases from malignant melanoma. A retrospective study over 10 years evaluated secondary intra-abdominal tumors from melanoma that required emergency or complication-related surgery. Surgeries for issues like intestinal necrosis, invagination, hemorrhage or perforation improved patient outcomes, with an average 14 month survival and 20% 5-year survival. Metastasectomy remains the only treatment that can provide a complete pathological response and favorable survival rates, even in a palliative context. Figures show examples of cutaneous melanoma, metastatic lymph nodes, FDG PET/CT findings, and intraoperative/CT images of small bowel invagination caused by melanoma.

1. SURGICAL APPROACH TO INTRA-ABDOMINAL
METASTASES FROM MALIGNANT MELANOMA
Authors: Octavia-Luciana Madge1, Sinziana Ionescu1, G. Dicu-Andreescu1, M.
Marincas1, Mirela Gherghe2, Madalina Radu3, Adina Ene3, Mihai Ceausu3, L. Simion1
Affiliation: 1- General and Oncological Surgery Clinic I of the Bucharest Oncological Institute
“Prof.Dr. Al. Trestioreanu ” 2- Nuclear Medicine Department of the Bucharest Oncological Institute
“Prof.Dr. Al. Trestioreanu ” 3-Pathology Department of the Bucharest Oncological Institute “Prof.Dr.
Al. Trestioreanu”
Purpose: The approach and surgical indication for patients with stage IV cancer are
debatable in terms of risk-benefit analysis. Surgery for malignant melanomas in the
metastatic stage can be performed in a scheduled or emergency context. Material
and method: A retrospective study was performed in the General and Oncological
Surgery Clinic I, during 10 years (2012-2021), in which the secondary intra-abdominal
determinations were evaluated, starting with a malignant melanoma. Reference was
made to cases presented in the emergency or which required surgery due to the
nature of the complications developed. Results: The surgeries performed for the
indication that imposed them (intestinal necrosis, invagination, haemorrhage,
perforation) had a positive impact on the clinical evolution of the respective patients
(average overall survival 14 months with a 5-year survival of 20%). Conclusions:
Metastasectomy remains the only treatment for malignant melanoma that can
provide a complete pathological response and has been associated with favourable
survival rates, even in the context of palliative surgery.
Figure 1a and 1b. Malignant cutaneous melanoma with different degrees of melanic
pigment distribution, evaluated both visually (left) and with the help of the digital
dermatoscope (right). Images from the collection of Dr. Alin Nicolescu
Figure 2: Secondary determinations from
cutaneous melanoma in a mesenteric lymph
node: Top left panel: Solid mass of tumor cells
without pigment deposition, HE, 50x, Top right
panel: strong positive (diffuse) reaction in S -
100 in tumor cells, bottom left panel: diffuse
positive reaction to HMB-45, IHC, 100x, bottom
right panel: diffuse positive reaction to MART-1
in tumor cells, IHC, 100x
Figure No. 3. 64-year-old man with recurrence from a malignant
melanoma of the left thigh, two years after the end of treatment;
supraclavicular lymph node and right adrenal mass showing high
uptake of F18-FDG.
4.a. 4.b. 4.c.
4.d. 4.e. 4.f.
Figure no.4. a, b and c: intraoperative appearance of the metastatic tumor of the small intestine (acromic
melanoma) causing intestinal invagination and images (4.d, e, f) computed tomography highlighting the intestinal
invagination, with a specific "donut-like" appearance