RADICAL RESECTION OF PRIMARY MALIGNANT-MELANOMA OF THE GALLBLADDER WITH MULTIPLE METASTASES - REPORT OF A CASE

We present herein an usual case of primary malignant melanoma of the g allbladder in a 51-year-old man in whom an exploratory laparotomy for melena revealed six malignant melanoma lesions located in the gallblad der, main pancreatic duct, stomach, duodenum, jejunum, and a mesenteri c lymph node. Total pancreatectomy was performed and histologically, j unctional activity was seen only in the gallbladder, suggesting that t his was the primary site. No melanotic lesions were found on the skin or eyes. The metastases to the main pancreatic duct and gastrointestin al tract appeared likely to have occurred as a consequence of the muco sal dissemination of the tumor cells shed into the bile. The post-oper ative course was uneventful and combined chemotherapy was administered for 16 months. No new metastatic lesions were found until 21 months p ostoperatively, when metastases were detected in the brain and thoraci c spinal cord. These metastatic tumors were removed surgically, but th e patient died from cerebral disturbance 26 months after the initial o peration. Thus, we consider that aggressive surgical therapy was effec tive for extending the survival time and improving the quality of life of this patient.