METASTASES TO THE BRAIN AND GALLBLADDER 1 0 YEARS AFTER LOCAL EXCISION OF A MALIGNANT CUTANEOUS MELANOMA

A 52-year-old man had a generalized seizure resulting in fracture of t wo vertebrae 10 years after excision of a superficially spreading mela noma (Clark level III) on the left flank. Additional to pain on pressu re over the right upper abdomen, the erythrocyte sedimentation rate wa s increased (41 mm) and the activity of the Liver enzymes was raised. Neurological examination indicated a loss of short-term memory, signs of meningeal irritation, unsteady gait and falling tendency. Cerebrosp inal fluid showed mild pleocytosis and cells suspicious of tumour. Upp er; abdominal ultrasonography revealed an enlarged gallbladder with co ntents of soft-tissue density. Magnetic resonance imaging showed numer ous round lesions in the brain which looked nodular after contrast-med ium injection. Cholecystectomy revealed metastases of a malignant mela noma. It was likely that the cerebral lesions also represented metasta ses. The confusional state increased in severity. Neither cytostatic d rugs nor radiotherapy were administered, because of the poor prognosis . The patient, now fully disorientated, died 54 days after hospital ad mission.