Melanoma
Elliott J. Yee, MD (he/him/his)
General Surgery Resident
University of Colorado - Anschutz, CO
Denver, Colorado, United States
Elliott J. Yee, MD (he/him/his)
General Surgery Resident
University of Colorado - Anschutz, CO
Denver, Colorado, United States
Otto N. Thielen, MD
Resident Physician
University of Colorado - Anschutz, CO, United States
Otto N. Thielen, MD
Resident Physician
University of Colorado - Anschutz, CO, United States
Ronald Truong, MD
Resident Physician
Danbury Hospital, United States
Danielle Gilbert, BA
Medical Student
University of Colorado - Anschutz, CO, United States
Kasey Couts, PhD
Assistant Professor
University of Colorado - Anschutz, CO, United States
William Robinson, MD PhD
Professor
University of Colorado - Anschutz, CO, United States
Camille L. Stewart, MD, FSSO, FACS (she/her/hers)
Surgical oncologist
CommonSpirit Health, St. Anthony Hospital
Lakewood, Colorado, United States
Martin D. McCarter, MD
Professor of Surgery
University of Colorado, Department of Surgery, United States
Cutaneous malignant melanoma is among the most common malignancies metastasizing to the gastrointestinal (GI) tract. Large-center data detailing the management and oncologic outcomes of patients with metastatic melanoma (MM) to the small bowel and colon in the era of immunotherapy is sparse. Herein, we describe our center’s experience and outcomes of surgically treated patients with cutaneous melanoma metastases to the small/large bowel considering the advent of immune checkpoint inhibitors (ICIs).
Methods:
Patients diagnosed with cutaneous MM with or without a known primary origin and small or large bowel metastasectomy from 2002 to 2023 were included. Patient demographics, clinicopathologic characteristics, surgical and non-surgical treatment, and oncologic outcomes were analyzed.
Results:
Thirty patients were included. A known primary cutaneous lesion was identified in 25 (83%) patients, but none was found in 5 (17%) patients. Most metastatic lesions involved the small bowel (n=24, 80%) and were solitary in number (n=16, 53%). Initial presentation of MM involved the GI tract in four patients (13%) whereas the remaining cohort had known metastases prior to GI dissemination. The most common operation performed was laparoscopic small bowl resection (n=12, 40%); 6 patients (20%) underwent emergent laparotomy most commonly for obstruction and/or bleeding. The median length of stay was 6 days with one patient (3%) experiencing Clavien-Dindo grade III or greater perioperative complications. Ten patients (30%) received ICI therapy prior to initial GI metastasectomy, whereas 15 patients (50%) received an ICI following their operation; only 7 patients (23%) received ICIs at both time points. In the overall cohort, the median follow-up time was 57 months with a median time to death and distant recurrence following GI metastasectomy of 10 and 5 months, respectively. No significant differences in time to death or recurrence following GI metastasectomy were observed with respect to ICI therapy (death, p=0.755; recurrence, p=0.169). The interval between primary lesion diagnosis and first GI metastasis was more than double in patients who received ICIs prior to GI metastasectomy compared to those who did not (69 vs 31 mos; p=0.089).
Conclusions:
Surgical intervention of symptomatic small bowel and colonic lesions from MM can be performed safely even in the emergent setting. Despite modern immunotherapy, outcomes in patients with GI melanoma metastases remain poor. Further study into the mechanisms of and potential targeted therapies against MM to the bowel is warranted.