Endoscopic diagnosis of melanoma

Background. Although skin melanoma is a tumour which can be localised visually, its current diagnosis remains unsatisfactory. Skin melanoma exhibits an extremely diverse clinical presentation and a highly variable progression of the neoplastic process.
Aim. To analyze our experience in diagnosing metastatic melanoma of the gastrointestinal tract.
Materials and methods. The paper presents data from endoscopic and morphological studies of 29 patients who were diagnosed with metastatic melanoma with lesions of the gastrointestinal tract at the Department of Endoscopy the N. Blokhin National Medical Research Centre of Oncology.
Results. Among the patients there were 12 (41.3 %) men and 17 (58.6 %) women, whose average age was 50 and 53 years, respectively, the majority of metastatic lesions of the gastrointestinal tract were asymptomatic, only 4 (13.8 %) patients had the disease accompanied by complaints such as difficulty passing food, in 2 cases (6.9 %) episodes of gastrointestinal bleeding were detected. In 7 (24.1 %) cases, the source of metastasis was not identified. The features of the manifestation of metastatic melanomas include the frequently combined lesions of the oesophagus, stomach and duodenum. In rare cases, there is a combination of pigmented and pigmented forms of melanoma.
Conclusion. Given the high potential for regional metastasis, the ability of melanoma to disseminate through the skin, the occurrence of multiple metastases even in the absence of local growth, and its often asymptomatic progression in gastrointestinal organs, the diagnostic protocol should encompass the full spectrum of endoscopic techniques. This includes esophagogastroduodenoscopy and colonoscopy, utilizing advanced methods such as narrow-band imaging, magnification, or a combination of both. Biopsy samples should be taken for morphological, cytological, and immunological analysis. Additionally, comprehensive diagnostic methods such as immunoscopy should be employed.

1. Blinov NN, Konstantinova MM. Melanoma of the skin. Risk and prognosis factors. Onconews. 2004;(4):2—4 (in Russ.).

2. Kaprin OV, Starinsky VV, Petrova GV. Malignant neoplasms in Russia in 2021 (morbidity and mortality). М., National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation. 2021 (in Russ.).

3. Nambisan RN. Early metastatic patterns and survival in malignant melanoma. J. Surg. Oncol. 1987;34(4):248—252. https://doi.org/10.1002/jso.2930340407

4. Branisteanu DC, Bogdanici CM, Branisteanu DE, Maranduca MA, Zemba M, Balta F, Branisteanu CI, Moraru AD. Uveal melanoma diagnosis and current treatment options (Review). Exp Ther Med. 2021 Dec;22(6):1428. https://doi.org/10.3892/etm.2021.10863

5. Ihde JK, Coit DG. Melanoma metastatic to stomach, small bowel, or colon. American Journal of Surgery. 1991 Sep;162(3):208—211. https://doi.org/10.1016/0002-9610(91)90070-t

6. Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery. 1984 Jun;95(6):635—639.

7. Kohoutova D, Worku D, Aziz H, Teare J, Weir J, Larkin J. Malignant Melanoma of the Gastrointestinal Tract: Symptoms, Diagnosis, and Current Treatment Options. Cells. 2021 Feb 5;10(2):327. https://doi.org/10.3390/cells10020327

8. Namikawa T, Hanazaki K. Clinicopathological features and treatment outcomes of metastatic tumors in the stomach. Surg Today. 2014 Aug;44(8):1392—1399. https://doi.org/10.1007/s00595-013-0671-9

9. Vukmirovic F, Vukmirovic M, Vukmirovic I. Multiple Simultaneos Metastases of Malignant Melanoma in the Stomach, Small and Large Intestine. Macedonian Journal of Medical Sciences. 2013 Mar 15;6(1):56—58. https://doi.org/10.3889/MJMS.1857-5773.2012.0269

10. Polyakov VG, Shishkov RV. Clinical guidelines for diagnosis and treatment of melanoma in children and adolescents. All-Russian Union of Public Associations Association of Oncologists of Russia project. 2014 (in Russ.).

11. Pirogov SS, Sokolov VV, Kaprin AD, Sokolov DV, Volchenko NN, Karpova ES, Sukhin DG, Pogorelov NN, Zaitsev AM. Metastatic gastric damage in skin melanoma: possibilities of multimodal endoscopic diagnostics. Experimental and clinical gastroenterology. 2017;8(144):79—86 (in Russ.).

12. Bobos M. Histopathologic classification and prognostic factors of melanoma: a 2021 update. Ital J Dermatol Venerol. 2021 Jun;156(3):300—321. https://doi.org/10.23736/S2784-8671.21.06958-3

13. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg. 1978 Jun;135(6):807—810. https://doi.org/10.1016/0002-9610(78)90171-x

14. Marak JR, Kumar T, Dwivedi S, Verma S. Primary malignant melanoma of the small bowel: A case report. Radiol Case Rep. 2024 Jan 6;19(3):1215—1221. https://doi.org/10.1016/j.radcr.2023.12.005

15. Wang S, Ling L, Xu C, Tang G. Primary malignant melanoma of the small intestine. Am J Med Sci. 2022 Nov;364(5):e12—e14. https://doi.org/10.1016/j.amjms.2022.06.014

16. Marone U, Caracò C, Losito S, Daponte A, Chiofalo MG, Mori S, Cerra R, Pezzullo l, Mozzillo N. Laparoscopic cholecystectomy for melanoma metastatic to the gallbladder: is it an adequate surgical procedure? Report of a case and review of the literature. World J Surg Oncol. 2007;(5):141. https://doi.org/10.1186/1477-7819-5-141