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Dtsch Med Wochenschr 2012; 137(09): 431-436
DOI: 10.1055/s-0031-1298947
Aktuelle Diagnostik & Therapie | Review article
Onkologie, Gastroenterologie, Dermatologie
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik intestinaler Metastasen bei Malignem Melanom

Diagnosis of intestinal metastases from malignant melanoma
J. G. Albert
,
P. Helmbold
2   Hautklinik, Universitätsklinikum Heidelberg
› Author Affiliations
Further Information

Publication History

05 September 2011

12 January 2012

Publication Date:
21 February 2012 (online)

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Zusammenfassung

Eine Metastase im Dünndarm tritt in 5 % bis 17 % der Melanom-Patienten auf, abhängig vom initialen Stadium der Erkrankung. Liegt zudem der Hinweis auf eine intestinalen Blutverlust vor, steigt die Wahrscheinlichkeit auf über 20 % und kann 72 % im metastasierten Stadium erreichen. Dünndarmmetastasen werden mit der Kapselendoskopie zuverlässig nachgewiesen. Extraintestinale, intraabdominelle Metastasen werden mit dem Ultraschall, der CT, MRT, oder PET-CT entdeckt. Beim Melanompatienten muss daher die endoskopische Abklärung einer Blutungsanämie oder einer overten intestinalen Blutung den Dünndarm mit einbeziehen. Auch ausgewählte Patienten im fortgeschrittenen Tumorstadium können für die Therapieplanung von einer Dünndarmendoskopie profitieren. Denn mit der Resektion einer intestinalen Metastase kann wahrscheinlich eine Verbesserung der Prognose erreicht werden, sofern alle Metastasen vollständig entfernt werden können.

Abstract

The small bowel harbors metastases of malignant melanoma in 5 % to 72 %, dependent on tumor stage and evidence of intestinal blood loss. Capsule endoscopy is sensitive in detecting small bowel metastasis. Computed tomography, magnetic resonance imaging, and PET-CT demonstrate extraintestinal intraabdominal metastases. Melanoma patients with signs of intestinal blood loss should be endoscopically investigated, including small bowel endoscopy. Selected patients in advanced tumor stage should also undergo small bowel endoscopy to plan a treatment strategy. A resection of intestinal metastases can improve the prognosis, if all metastases are removed.

Schlüsselwörter

Malignes Melanom - Metastasen

Keywords

malignant melanoma - metastases
 

  • Literatur

  • 1 Agrawal S, Yao TJ, Coit DG. Surgery for melanoma metastatic to the gastrointestinal tract. Ann Surg Oncol 1999; 6: 336-344
    CrossrefPubMedGoogle Scholar
  • 2 Albert JG, Fechner M, Fiedler E et al. Algorithm for detection of small-bowel metastasis in malignant melanoma of the skin. Endoscopy 2011; 43: 490-498
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Albert JG, Gimm O, Stock K et al. Small-bowel endoscopy is crucial for diagnosis of melanoma metastases to the small bowel: a case of metachronous small bowel metastases and review of the literature. Melanoma Res 2007; 17: 335-338
    CrossrefPubMedGoogle Scholar
  • 4 Amar A, Jougon J, Edouard A et al. Melanome malin primitif de l'intestin grele. Gastroenterol Clin Biol 1992; 16: 365-367
    PubMedGoogle Scholar
  • 5 Amersi FF, Terando AM, Goto Y et al. Activation of CCR9/CCL25 in Cutaneous Melanoma Mediates Preferential Metastasis to the Small Intestine. Clin Cancer Res 2008; 14: 638-645
    CrossrefPubMedGoogle Scholar
  • 6 Bailey AA, Debinski HS, Appleyard MN et al. Diagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience. Am J Gastroenterol 2006; 101: 2237-2243
    CrossrefPubMedGoogle Scholar
  • 7 Balch CM, Soong S, Ross MI et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol 2000; 7: 87-97
    CrossrefPubMedGoogle Scholar
  • 8 Balch CM, Soong SJ, Gershenwald JE et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001; 19: 3622-3634
    PubMedGoogle Scholar
  • 9 Berger AC, Buell JF, Venzon D et al. Management of symptomatic malignant melanoma of the gastrointestinal tract. Ann Surg Oncol 1999; 6: 155-160
    CrossrefPubMedGoogle Scholar
  • 10 Blecker D, Abraham S, Furth EE et al. Melanoma in the gastrointestinal tract. Am J Gastroenterol 1999; 94: 3427-3433
    CrossrefPubMedGoogle Scholar
  • 11 Blessing K, McLaren KM. Histological regression in primary cutaneous melanoma: recognition, prevalence and significance. Histopathology 1992; 20: 315-322
    CrossrefPubMedGoogle Scholar
  • 12 Brady MS, Kavolius JP, Quan SH. Anorectal melanoma. A 64-year experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum 1995; 38: 146-151
    CrossrefPubMedGoogle Scholar
  • 13 Branum GD, Seigler HF. Role of surgical intervention in the management of intestinal metastases from malignant melanoma. Am J Surg 1991; 162: 428-431
    CrossrefPubMedGoogle Scholar
  • 14 Caputy GG, Donohue JH, Goellner JR et al. Metastatic melanoma of the gastrointestinal tract. Results of surgical management. Arch Surg 1991; 126: 1353-1358
    CrossrefPubMedGoogle Scholar
  • 15 Chapman PB, Hauschild A, Robert C et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 2011; 364: 2507-2516
    CrossrefPubMedGoogle Scholar
  • 16 Das Gupta T, Brasfield R. Metastatic melanoma of the gastrointestinal tract. Arch Surg 1964; 88: 969-973
    CrossrefPubMedGoogle Scholar
  • 17 De La Pava S, Nigogosyan G, Pickren JW et al. Melanosis of the esophagus. Cancer 1963; 16: 48-50
    CrossrefPubMedGoogle Scholar
  • 18 Derose ER, Pleet A, Wang W et al. Utility of 3-year torso computed tomography and head imaging in asymptomatic patients with high-risk melanoma. Melanoma Res 2011; 21: 364-369
    CrossrefPubMedGoogle Scholar
  • 19 Elsayed AM, Albahra M, Nzeako UC et al. Malignant melanomas in the small intestine: a study of 103 patients. Am J Gastroenterol 1996; 91: 1001-1006
    PubMedGoogle Scholar
  • 20 Eng J, Pradhan GN, Sabanathan S et al. Malignant melanoma metastatic to the esophagus. Ann Thorac Surg 1989; 48: 287-288
    CrossrefPubMedGoogle Scholar
  • 21 Garbe C, Peris K, Hauschild A et al. Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline. Eur J Cancer 2010; 46: 270-283
    CrossrefPubMedGoogle Scholar
  • 22 Gutman H, Hess KR, Kokotsakis JA et al. Surgery for abdominal metastases of cutaneous melanoma. World J Surg 2001; 25: 750-758
    CrossrefPubMedGoogle Scholar
  • 23 Hodi FS, O'Day SJ, McDermott DF et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 2010; 363: 711-723
    CrossrefPubMedGoogle Scholar
  • 24 Hornbuckle J, Culjak G, Jarvis E et al. Patterns of metastases in familial and non-familial melanoma. Melanoma Res 2003; 13: 105-109
    CrossrefPubMedGoogle Scholar
  • 25 Huprich JE, Fletcher JG, Fidler JL et al. Prospective Blinded Comparison of Wireless Capsule Endoscopy and Multiphase CT Enterography in Obscure Gastrointestinal Bleeding. Radiology 2011; 260: 744-751
    CrossrefPubMedGoogle Scholar
  • 26 Ihde JK, Coit DG. Melanoma metastatic to stomach, small bowel, or colon. Am J Surg 1991; 162: 208-211
    CrossrefPubMedGoogle Scholar
  • 27 Joob AW, Haines 3 GK, Kies MS et al. Primary malignant melanoma of the esophagus. Ann Thorac Surg 1995; 60: 217-222
    CrossrefPubMedGoogle Scholar
  • 28 Kamel IR, Kruskal JB, Gramm HF. Imaging of abdominal manifestations of melanoma. Crit Rev Diagn Imaging 1998; 39: 447-486
    PubMedGoogle Scholar
  • 29 Kamposioras K, Pentheroudakis G, Pectasides D et al. Malignant melanoma of unknown primary site. To make the long story short. A systematic review of the literature. Crit Rev Oncol Hematol 2011; 78: 112-126
    CrossrefPubMedGoogle Scholar
  • 30 Klaase JM, Kroon BB. Surgery for melanoma metastatic to the gastrointestinal tract. Br J Surg 1990; 77: 60-61
    CrossrefPubMedGoogle Scholar
  • 31 Krige JE, Nel PN, Hudson DA. Surgical treatment of metastatic melanoma of the small bowel. Am Surg 1996; 62: 658-663
    PubMedGoogle Scholar
  • 32 Lee CC, Faries MB, Wanek LA et al. Improved survival for stage IV melanoma from an unknown primary site. J Clin Oncol 2009; 27: 3489-3495
    CrossrefPubMedGoogle Scholar
  • 33 Leiter U, Buettner PG, Eigentler TK et al. Hazard rates for recurrent and secondary cutaneous melanoma: An analysis of 33,384 patients in the German Central Malignant Melanoma Registry. J Am Acad Dermatol 2011; Jun 21 [Epub ahead of print]
    PubMedGoogle Scholar
  • 34 Lens M, Bataille V, Krivokapic Z. Melanoma of the small intestine. Lancet Oncol 2009; 10: 516-521
    CrossrefPubMedGoogle Scholar
  • 35 May A, Albert J, Keuchel M et al. Kapselendoskopie in der Diagnostik von Dunndarmerkrankungen. Update des Positionspapiers der Sektion Endoskopie der DGVS, Stand 07 / 2010. Z Gastroenterol 2010; 48: 1384-1404
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Meier F, Will S, Ellwanger U et al. Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 2002; 147: 62-70
    CrossrefPubMedGoogle Scholar
  • 37 Ollila DW, Essner R, Wanek LA et al. Surgical resection for melanoma metastatic to the gastrointestinal tract. Arch Surg 1996; 131: 975-9; 979-980
    CrossrefPubMedGoogle Scholar
  • 38 Ollila DW. Complete metastasectomy in patients with stage IV metastatic melanoma. Lancet Oncol 2006; 7: 919-924
    CrossrefPubMedGoogle Scholar
  • 39 Panagiotou I, Brountzos EN, Bafaloukos D et al. Malignant melanoma metastatic to the gastrointestinal tract. Melanoma Res 2002; 12: 169-173
    CrossrefPubMedGoogle Scholar
  • 40 Patel JK, Didolkar MS, Pickren JW et al. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 1978; 135: 807-810
    CrossrefPubMedGoogle Scholar
  • 41 Patnana M, Bronstein Y, Szklaruk J et al. Multimethod imaging, staging, and spectrum of manifestations of metastatic melanoma. Clin Radiol 2011; 66: 224-236
    CrossrefPubMedGoogle Scholar
  • 42 Pfannenberg C, Aschoff P, Schanz S et al. Prospective comparison of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer 2007; 43: 557-564
    CrossrefPubMedGoogle Scholar
  • 43 Prakoso E, Fulham M, Thompson JF et al. Capsule endoscopy versus positron emission tomography for detection of small-bowel metastatic melanoma: a pilot study. Gastrointest Endosc 2011; 73: 750-756
    CrossrefPubMedGoogle Scholar
  • 44 Prakoso E, Selby WS. Capsule endoscopy in patients with malignant melanoma. Am J Gastroenterol 2007; 102: 1204-1208
    CrossrefPubMedGoogle Scholar
  • 45 Reintgen DS, Thompson W, Garbutt J et al. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery 1984; 95: 635-639
    PubMedGoogle Scholar
  • 46 Ricaniadis N, Konstadoulakis MM, Walsh D et al. Gastrointestinal metastases from malignant melanoma. Surg Oncol 1995; 4: 105-110
    CrossrefPubMedGoogle Scholar
  • 47 Richmond A. CCR9 Homes Metastatic Melanoma Cells to the Small Bowel. Clin Cancer Res 2008; 14: 621-623
    CrossrefPubMedGoogle Scholar
  • 48 Robert C, Thomas L, Bondarenko I et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med 2011; 364: 2517-2526
    CrossrefPubMedGoogle Scholar
  • 49 Sachs DL, Lowe L, Chang AE et al. Do primary small intestinal melanomas exist? Report of a case. J Am Acad Dermatol 1999; 41: 1042-1044
    CrossrefPubMedGoogle Scholar
  • 50 Sanki A, Scolyer RA, Thompson JF. Surgery for melanoma metastases of the gastrointestinal tract: indications and results. Eur J Surg Oncol 2009; 35: 313-319
    CrossrefPubMedGoogle Scholar
  • 51 Schuchter LM, Green R, Fraker D. Primary and metastatic diseases in malignant melanoma of the gastrointestinal tract. Curr Opin Oncol 2000; 12: 181-185
    CrossrefPubMedGoogle Scholar
  • 52 Schwartz GD, Barkin JS. Small-bowel tumors detected by wireless capsule endoscopy. Dig Dis Sci 2007; 52: 1026-1030
    CrossrefPubMedGoogle Scholar
  • 53 Stranks GJ, Mathai JT, Rowe-Jones DC. Primary malignant melanoma of the oesophagus: case report and review of surgical pathology. Gut 1991; 32: 828-830
    CrossrefPubMedGoogle Scholar
  • 54 Tessier DJ, McConnell EJ, Young-Fadok T et al. Melanoma metastatic to the colon: case series and review of the literature with outcome analysis. Dis Colon Rectum 2003; 46: 441-447
    CrossrefPubMedGoogle Scholar
  • 55 Tyler DS, Onaitis M, Kherani A et al. Positron emission tomography scanning in malignant melanoma. Cancer 2000; 89: 1019-1025
    CrossrefPubMedGoogle Scholar
  • 56 Wood TF, DiFronzo LA, Rose DM et al. Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival?. Ann Surg Oncol 2001; 8: 658-662
    CrossrefPubMedGoogle Scholar