Melanoma of the gallbladder - A review of cases seen at Duke University Medical Center

BACKGROUND. Both primary and metastatic melanoma of the gallbladder are rar e. In cases involving isolated tumors of the gallbladder, there continues t o be controversy regarding the establishment of primary status. Despite app ropriate therapy, the diagnosis of either condition portends a poor prognos is, with few patients surviving more than 2 years. METHODS, A review of all patients seen at Duke University Medical Center si nce 1970 generated 1 case of primary and 19 cases of secondary melanoma of the gallbladder. These were analyzed with respect to presentation, clinical and patho logic diagnosis, treatment, and prognosis. RESULTS, The sole patient with a primary lesion presented with acute cholec ystitis. Ultrasound demonstrated a mass in the lumen of the gallbladder, Ch olecystectomy revealed melanoma, and the patient eventually died of dissemi nated disease 13.5 months later. Survival was poor for patients who present ed with metastases to the gallbladder in the setting of widespread disease, with 0% survival at 1 year (n = 11). Those with isolated, resectable lesio ns fared better overall, with 100% survival (n = 6) at 1 year. One patient remains alive and free of disease 13.8 years later, which, to our knowledge , represents the longest documented survival for a patient with melanoma th at has metastasized to the gallbladder. CONCLUSIONS. Surgery remains the mainstay of therapy for patients with gall bladder melanoma and appears to improve patient outcome in the setting of r esectable disease. Hopefully, further investigations will lead to standardi zed protocols for the treatment of these lesions. Cancer 1999;85:32-9. (C) 1999 American Cancer Society.