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Pathogenesis, diagnosis and management of primary melanoma of the colon.

Khalid U, Saleem T, Imam AM, Khan MR - World J Surg Oncol (2011)

Bottom Line: The average age of patients on presentation was 60.4 years without any significant gender predilection.Although the management was individualized in every case, most of the authors preferred traditional hemicolectomy as the favored surgical approach.Two of these 9 (22.2%) patients died.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of General Surgery, Department of Surgery, Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.

ABSTRACT

Background: Melanomas within the alimentary tract are usually metastatic in origin. On the other hand, primary melanomas of the gastrointestinal tract are relatively uncommon. There are several published reports of melanomas occurring in the esophagus, stomach, small bowel, and anorectum. The occurrence of primary melanoma of the colon has, however, only been rarely reported. The optimum modus operandi for the management of primary colonic melanoma remains nebulous due to the limited number of reports in literature.

Methods: A comprehensive search of Medline, Cochrane and Highwire was performed using the following keywords: 'melanoma', 'malignant melanoma', 'primary melanoma', 'colon', 'gastrointestinal tract', 'alimentary tract', 'digestive tract', and 'large bowel'. All patients with primary melanoma localized to the colon were included in the review. Patients with metastatic melanomas to the gastrointestinal (GI) tract and primary melanomas localized to the GI tract in anatomic locations other than colon were excluded.

Results: There have been only 12 reported cases of primary melanoma of the colon to date. The average age of patients on presentation was 60.4 years without any significant gender predilection. Right colon (33%) and cecum (33%) were the most common sites for the occurrence of primary colonic melanoma while abdominal pain (58%) and weight loss (50%) were the most common presenting complaints. Colonoscopy is the most reliable diagnostic investigation and offers the additional advantage of obtaining tissue for diagnosis. S-100 and HMB-45 are highly sensitive and specific for the diagnosis of this malignancy. For primary colonic melanomas that have not metastasized to any distant parts of the body, surgical resection with wide margins appears to be the treatment of choice. Although the management was individualized in every case, most of the authors preferred traditional hemicolectomy as the favored surgical approach. Chemotherapeutic agents including interferons, cytokines, biological agents and radiation therapy for brain metastases have been reported as adjuvant and palliative options while considering malignant melanomas in general. The average recurrence-free interval was 2.59 years. Nine of the 12 reports documented follow-up in their patients. Two of these 9 (22.2%) patients died.

Conclusions: Primary melanoma of the colon is a rare clinical entity. Whenever a seemingly primary melanoma is detected in an atypical location such as the colon, it is prudent to conduct a thorough clinical investigation to consider the possibility of metastatic disease. Further studies are needed to document the long term follow-up, survival advantage and safety of the management approaches employed in patients with primary colonic melanoma. Based on current data, surgical resection appears to be appropriate management for primary colonic melanomas; unless the disease has metastasized to distant sites where surgery may have a limited palliative role.

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Related in: MedlinePlus

Comparison of anatomic distribution in primary and metastatic melanoma of colon.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Comparison of anatomic distribution in primary and metastatic melanoma of colon.

Mentions: Right colon and cecum were found to be the most common sites for the occurrence of primary colonic melanomas as depicted in Figure 1. This was slightly different from the data on metastatic colonic melanomas, where ascending colon and descending colon were reported as the predominant sites involved [17]. Figure 1 shows a comparison of the sites involved in primary and metastatic colonic melanoma.


Pathogenesis, diagnosis and management of primary melanoma of the colon.

Khalid U, Saleem T, Imam AM, Khan MR - World J Surg Oncol (2011)

Comparison of anatomic distribution in primary and metastatic melanoma of colon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040702&req=5

Figure 1: Comparison of anatomic distribution in primary and metastatic melanoma of colon.
Mentions: Right colon and cecum were found to be the most common sites for the occurrence of primary colonic melanomas as depicted in Figure 1. This was slightly different from the data on metastatic colonic melanomas, where ascending colon and descending colon were reported as the predominant sites involved [17]. Figure 1 shows a comparison of the sites involved in primary and metastatic colonic melanoma.

Bottom Line: The average age of patients on presentation was 60.4 years without any significant gender predilection.Although the management was individualized in every case, most of the authors preferred traditional hemicolectomy as the favored surgical approach.Two of these 9 (22.2%) patients died.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of General Surgery, Department of Surgery, Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.

ABSTRACT

Background: Melanomas within the alimentary tract are usually metastatic in origin. On the other hand, primary melanomas of the gastrointestinal tract are relatively uncommon. There are several published reports of melanomas occurring in the esophagus, stomach, small bowel, and anorectum. The occurrence of primary melanoma of the colon has, however, only been rarely reported. The optimum modus operandi for the management of primary colonic melanoma remains nebulous due to the limited number of reports in literature.

Methods: A comprehensive search of Medline, Cochrane and Highwire was performed using the following keywords: 'melanoma', 'malignant melanoma', 'primary melanoma', 'colon', 'gastrointestinal tract', 'alimentary tract', 'digestive tract', and 'large bowel'. All patients with primary melanoma localized to the colon were included in the review. Patients with metastatic melanomas to the gastrointestinal (GI) tract and primary melanomas localized to the GI tract in anatomic locations other than colon were excluded.

Results: There have been only 12 reported cases of primary melanoma of the colon to date. The average age of patients on presentation was 60.4 years without any significant gender predilection. Right colon (33%) and cecum (33%) were the most common sites for the occurrence of primary colonic melanoma while abdominal pain (58%) and weight loss (50%) were the most common presenting complaints. Colonoscopy is the most reliable diagnostic investigation and offers the additional advantage of obtaining tissue for diagnosis. S-100 and HMB-45 are highly sensitive and specific for the diagnosis of this malignancy. For primary colonic melanomas that have not metastasized to any distant parts of the body, surgical resection with wide margins appears to be the treatment of choice. Although the management was individualized in every case, most of the authors preferred traditional hemicolectomy as the favored surgical approach. Chemotherapeutic agents including interferons, cytokines, biological agents and radiation therapy for brain metastases have been reported as adjuvant and palliative options while considering malignant melanomas in general. The average recurrence-free interval was 2.59 years. Nine of the 12 reports documented follow-up in their patients. Two of these 9 (22.2%) patients died.

Conclusions: Primary melanoma of the colon is a rare clinical entity. Whenever a seemingly primary melanoma is detected in an atypical location such as the colon, it is prudent to conduct a thorough clinical investigation to consider the possibility of metastatic disease. Further studies are needed to document the long term follow-up, survival advantage and safety of the management approaches employed in patients with primary colonic melanoma. Based on current data, surgical resection appears to be appropriate management for primary colonic melanomas; unless the disease has metastasized to distant sites where surgery may have a limited palliative role.

Show MeSH
Related in: MedlinePlus