Management of symptomatic malignant melanoma of the gastrointestinal tract

Background: Melanoma metastatic to the gastrointestinal (GI) tract is asymp tomatic or presents with pain, bleeding, or obstruction. To determine wheth er surgery influences outcomes, we reviewed our experience with this patien t population. Methods: Medical records of patients with metastatic melanoma to the GI tra ct were reviewed. Patients were divided into four groups, i.e., complete re section, partial debulking, unresectable, or unexplored. Analysis was perfo rmed using the Kaplan-Meier method. Results: Fifty patients with melanoma metastatic to the GI tract were ident ified (40 men and 10 women; mean age, 44 years). Presenting symptoms includ ed pain (62%), bleeding (28%), and obstruction (18%). Diagnosis was confirm ed using contrast studies (38%), endoscopy (20%), or computed tomography (3 0%). Thirty-six patients (61%) underwent a total of 39 operations. Seventee n patients underwent complete resection, whereas 14 underwent partial debul king. Five patients had unresectable lesions, and 14 patients did not under go exploration because of medical contraindications. The operative mortalit y rate was 2.5% (1 of 39). The mean survival times for the unexplored and u nresected groups were similar (4.1 months). Patients who underwent partial resection exhibited a longer mean survival time (8.9 months) than did patie nts in the unresected group (P < .001). The complete-resection group demons trated a mean survival time of 23.5 months, which was significantly longer than that for patients who underwent less than complete resection (P < .000 1). Conclusions: Metastatic melanoma to the GI tract can result in significant morbidity and death. Surgical resection can be performed safely. Patients f or whom all sites of disease are completely resected experience significant improvements in survival times, compared with patients who undergo less th an complete resection. For selected patients, surgical treatment of metasta tic melanoma involving the GI tract is appropriate therapy.