Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2023; 15(1): 205-214
Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.205
Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception: A case report
Wen-Juan Fan, Heng-Hui Cheng, Wang Wei
Wen-Juan Fan, Wang Wei, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Wen-Juan Fan, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Wuhan 430030, Hubei Province, China
Heng-Hui Cheng, Institution of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Fan WJ reviewed the literature and contributed to manuscript drafting and imaging data interpretation; Cheng HH evaluated all pathological information of the patient and provided pathological pictures; Wei W was responsible for revising the manuscript for important intellectual content; all authors provided approval of the final version for submission and publication.
Supported by National Natural Science Foundation of China, No. 82100568.
Informed consent statement: Informed written consent was obtained from the family members of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wang Wei, MD, Attending Doctor, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avanue, Wuhan 430030, Hubei Province, China. eric21cn@163.com
Received: November 5, 2022
Peer-review started: November 5, 2022
First decision: November 23, 2022
Revised: November 24, 2022
Accepted: December 13, 2022
Article in press: December 13, 2022
Published online: January 15, 2023
Processing time: 66 Days and 3.6 Hours
Abstract
BACKGROUND

Melanoma is the most aggressive form of skin cancer, with a tendency to metastasize to any organ. Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide. Small intestine cancers especially small intestine metastases are relatively rare. Small intestine metastases are seldom described and likely underdiagnosed. Intussusception is most common in pediatric age, and in adults are almost 5% of all cases.

CASE SUMMARY

A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital, complaining of intermittent melena for 1 mo. Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass, indicating a neoplastic lesion with jejunojejunal intussusception. The patient underwent partial small bowel resection. Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma. The patient refused further anti-tumor treatment after the surgery. Ten months after the first surgery, the patient presented with melena again. Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall, and routine conservative treatment was given. Three months later, the patient developed melena again. The patient underwent a second surgery, and multiple metastatic melanoma lesions were found. The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.

CONCLUSION

Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.

Keywords: Melanoma; Metastasis; Gastrointestinal hemorrhage; Intussusception; Small bowel resection; Case report

Core Tip: Malignant melanoma is one of the most aggressive forms of skin cancer, with a high metastatic potential and poor prognosis. We report a patient who presented with intermittent melena and history of acral malignant melanoma. Abdominal imaging showed a neoplastic lesion of the small intestine with intussusception formation. Postoperative pathology confirmed small intestine metastatic melanoma. The patient refused further comprehensive treatment including immunotherapy and chemotherapy and experienced disease relapse 1 year later. The patient underwent a second surgery, which revealed multiple small intestine metastatic melanoma lesions. The patient was alive at last follow-up without receiving adjuvant anti-tumor therapy.