Primary Malignant Melanoma of the Oesophagus

Primary malignant melanoma arising in the oesophagus is a rare condition with a dismal prognosis. The diagnosis is often made following surgical resection even though the endoscopic features may be pathognomonic. The classical treatment is oesophagectomy even though the advanced disease stage at the time of presentation and aggressive biological behaviour of the tumour usually results in a fatal outcome. We report the case of a male patient initially diagnosed with squamous oesophageal carcinoma and treated with conventional neo-adjuvant chemo-radiotherapy. Poor clinical and radiological response resulted in a review of the original histology confirming a diagnosis of primary malignant melanoma of the oesophagus. The subsequent alteration in management conferred the patient an improved quality of life. A short review of the literature on primary malignant melanoma of the oesophagus supplements this case report.     

Primary Malignant Melanoma of Maxillary Gingiva

Malignant melanoma of maxillary gingiva is a rare clinical entity. Mucosal melanoma is more aggressive than cutaneous form and carries comparatively poorer prognosis. High index of suspicion is required for diagnosing malignant melanoma of oral cavity. Any pigmented lesion in the oral cavity should be taken seriously by the clinician.     

肛管直肠恶性黑色素瘤的诊治进展

目的：探讨肛管直肠恶性黑色素瘤的诊治进展，方法：复习相关文献并对本病病因，临床特点，早期诊断，治疗及预后作一综述报告。结果：肛管直肠恶性黑色素瘤是一种发病率很低的恶性肿瘤，发病原因可能与良性黑痔史，HIV感染，太阳光照射有关，主要症有便血，局部肿块，大便习惯改变等，早期诊断主要依赖对45－80岁的高危发病人群进行常规直肠检查，CEA多克隆抗体标记阳性在病理诊断中有一定帮助，治疗方法现存在争议，多主张在手术治疗（腹会阴联合切除或局部广泛切除）的基础上辅以化疗，放疗或免疫治疗。结论：肛管直肠恶性黑色素瘤早期诊断困难，预后差，应提高警惕，最佳治疗方法还有待进一步探讨。     

Primary Malignant Melanoma of the Small Intestine: a Case Report

The small intestine is the most common site of gastro-intestinal metastasis from cutaneous malignant melanoma. A primary origin at this site has been reported in rare cases. We report a case of a 71-year-old man with a primary malignant melanoma in the jejunum. The patient presented with weakness, weight loss, non-specific abdominal pain and episodes of fainting. After clinical examination, laboratory evaluation and radiological work-up, which included CT of the abdomen, the patient was diagnosed with a tumour mass in the jejunum. This diagnosis was confirmed at laparotomy. The patient underwent enterectomy with wide excision of the tumour. A primary malignant melanoma of the small intestine is an extremely rare neoplasm.

A definite diagnosis can only be made after a thorough investigation has been made to exclude the co-existence of a primary lesion elsewhere. Curative resection of the tumour remains the treatment of choice.     

Malignant Melanoma of the Gallbladder: A Report of Two Cases and Review of the Literature

Melanoma metastatic to the gallbladder is rare. When present, it is often part of a widespread complex of metastases. Primary gallbladder melanomas are also extremely rare and can sometimes be difficult to distinguish from metastatic lesions. The optimal treatment for malignant melanoma of the gallbladder remains unclear, and prognosis is generally poor. We present here two cases of patients with metastatic lesions to the gallbladder. One patient presented with symptomatic cholelithiasis and was found incidentally to have a metastasis. Another patient had known a metastasis, but underwent curative resection of the only site of disease. We review the published literature for gallbladder melanoma, both primary and metastatic to determine the role of surgery in this disease.     

Primary Malignant Melanoma of the Small Intestine: Report of a Case

The small intestine is the most common site of gastrointestinal (GI) metastases from cutaneous malignant melanoma; however, primary malignant melanoma originating in the small intestine is extremely rare. We report the case of a 72-year-old man found to have a primary malignant melanoma in the ileum. The patient presented with anorexia, weight loss, diffuse colicky abdominal pain, and episodic rectal bleeding. A preoperative diagnosis of a small intestinal tumor was based on the findings of enteroclysis and computed tomography scanning. This diagnosis was confirmed at laparotomy and an enterectomy was performed. Histopathological examination of the resected specimen clarified the exact nature of the lesion, confirming the diagnosis of melanoma. A thorough postoperative investigation did not reveal a primary lesion in the skin, anus, oculus, or any other location. Thus, we diagnosed this tumor as a primary lesion. One year after his operation, the patient remains well without any evidence of recurrence. Primary malignant melanoma of the small intestine is an extremely rare lesion, which must be differentiated from other intestinal tumors. Received: August 6, 2001 / Accepted: March 5, 2002     

The Diagnostic Value of Endoscopic Ultrasonography and Magnetic Resonance Imaging for Anorectal Malignant Melanoma: Report of a Case

A 74-year-old Japanese woman presented with a 3-month history of anal bleeding. Proctoscopy revealed an unusual polypoid lesion with focal pigmentation at the dentate line, which was histologically diagnosed as a malignant melanoma. Whole-body clinical and radiographic evaluations revealed no alternative primary source. Endoscopic ultrasonography (EUS) showed well-delineated hypoechoic tumors invading the muscularis propria, and magnetic resonance imaging (MRI) revealed regional lymphadenopathy. Following this evaluation, an abdominoperineal resection with regional lymphadenectomy was performed. The excised tumor was histologically confirmed to be malignant melanoma, and its depth and metastatic lymph nodes proved to have been accurately and precisely evaluated by the preoperative examinations. Thus, EUS and MRI are useful preoperative diagnostic tools for the tumor staging of primary anorectal malignant melanomas, as for other rectal tumors. Received: February 1, 2002 / Accepted: September 3, 2002 Reprint requests to: H. Sashiyama     

Aminolaevulinic Acid-induced Photodynamic Therapy in the Treatment of Dysplastic Barrett's Oesophagus and Adenocarcinoma

. Photodynamic therapy (PDT) may have a role in the prevention of oesophageal cancer. Ten patients with Barrett's oesophagus, three with low-grade dysplasia (LGD), four with high-grade dysplasia (HGD), one with carcinoma in situ and two with invasive carcinoma, were treated with PDT. All received 30 mg/kg aminolaevulinic acid (ALA) followed 4 h later by laser endoscopy. Half were treated with red light (630 nm; 100 mW/cm² for 1000 s) and half with green light (514 nm; 100 mW/cm² for 500 s). Columnar epithelial regression was seen in all patients with dysplasia (mean area decrease 44%; range 10–100%), with apparent elimination of dysplasia in all cases. In patients with in situ or invasive carcinoma, no response was seen. ALA-induced PDT, using either red or green light, produces effective ablation of dysplastic Barrett's oesophagus, hence may have a role in the prevention of oesophageal carcinoma, but has little effect on in situ or invasive adenocarcinoma. Paper received 3 January 1999; accepted after revision 12 April 1999.     

Metastatic Melanoma Causing Jejunal Intussusception

The gastrointestinal (GI) tract is a common site of melanoma metastases although reports of small bowel intussusception are relatively rare. Most patients with intussusception will be symptomatic and resection will provide significant palliation. In rare instances, patients will have solitary metastases to the small intestine, and resection can provide long-term palliation and chance for cure. We describe a case of a patient with a widely metastatic melanoma who presented with crampy abdominal pain and CT findings of small bowel metastases. Exploration revealed jejunojejunal intussusception and resection provided excellent palliation.     

Soft Tissue Reconstruction of the Foot Using the Distally Based Island Pedicle Flap after Resection of Malignant Melanoma

Background

We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients.

Methods

A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for 3 cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas.

Results

The length of the flap varied from 7.5 cm to 12 cm (mean, 9.6 cm) and the width varied from 6.5 cm to 12 cm (mean, 8.8 cm). Superficial necrosis developed in four flaps, but this was successfully treated by debridement and suture or a skin graft. All thirteen flaps survived completely and they provided good contour, stable and durable coverage for normal weight bearing.

Conclusions

The distally based sural flap is considered to be useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral archs of the mid- and forefoot after resection of malignant melanoma of the foot.     

Malignant Melanoma of the Kidney Presenting as a Primary Tumor

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 74-year-old woman. The patient underwent a right radical nephrectomy, and has been living tumor free for 2 years and 3 months. This is the first reported case of primary renal malignant melanoma. We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.     

血液指标及18F-FDG PET/CT在恶性黑色素瘤淋巴结转移中的应用价值

目的 探讨血液指标及18F-FDG PET/CT在恶性黑色素瘤淋巴结转移中的应用价值。 方法 收集我院2020年7月-2023年5月收治的17例恶性黑色素瘤患者的血液指标,分析6种血液指标在淋巴结转移组与非转移组之间的差异性及PET/CT检查结果,并运用Pearson相关分析SUVmax值与差异性血液指标的相关性。 结果 转移组LDH水平高于非转移组（P＜0.05）;两组余白蛋白、球蛋白、CRP、NLR、PLR指标比较,差异无统计学意义（P＞0.05）;淋巴结转移组LDH与SUVmax值呈正相关（r=0.417, P＜0.05）。 结论LDH及18F-FDG PET/CT对诊断恶性黑色素瘤淋巴结转移具有一定的价值。     

Malignant melanoma of the anorectum: report of four cases

Four cases of anorectal malignant melanoma are reported in this paper. All patients underwent an abdominoperineal resection with lymph node dissection for a curative operation and received postoperative chemotherapy with dacarbazine, ranimustine, and vincristine, either with or without interferon-β. One of these patients has been observed for more than 6 years postoperatively without any evidence of recurrence. The other three patients had advanced diseases at the time of diagnosis, and died within 3 years after operation. The prognosis of anorectal malignant melanoma is considered to be directly related to tumor size and depth. Therefore, a staging system and treatments based on the tumor size and depth (or thickness) are needed. Received: March 28, 2001 / Accepted: November 20, 2001     

肛管直肠恶性黑色素瘤

目的　总结肛管直肠恶性黑色素瘤的诊断与治疗经验。　方法　回顾性分析 10例肛管直肠恶性黑色素瘤的临床病例资料。　结果　出现症状至确诊时间平均 8( 2～ 12 )个月 ,首诊确诊 4例 ,误诊 6例。手术 9例 ,8例肿瘤直径 >3cm。其中 8例行腹会阴联合根治术 ,1例以直肠息肉、肛乳头肥大行局部切除 ,1例放弃手术仅行化疗 ,3月后死于肝、肺腹股沟等广泛转移。术后 8例行化疗 ,2例辅助放疗 ,化放疗联合应用 1例。术后 2年内死亡 5例 ,余 4例存活 ,存活最长者已超过 6年。　结论　肛管直肠恶性黑色素瘤恶性程度高 ,早期行腹会阴联合根治术是最优选择。长期生存有赖于早期治疗以及治疗方法的改进     

黑色素瘤抗体治疗研究进展

黑色素瘤是一类起源于神经嵴黑色素细胞的高度恶性肿瘤,易发生远处转移,转移性黑色素瘤患者的预后很差。近年来,免疫治疗逐渐成为黑色素瘤治疗的新方向,越来越多的免疫药物被用于临床治疗。其中,对T细胞肿瘤免疫研究日益深入,多个有治疗意义的T细胞调节通路位点和共刺激分子被发现,并被用于加强对黑色素细胞瘤的免疫反应。本文就两种单克隆抗体,即程序死亡分子1(PD-1)和抗细胞毒性T淋巴细胞相关抗原4(CTLA-4),以及两种共刺激分子OX40和4-1BB在近年的研究进展进行综述。     

Amelanotic Malignant Melanoma of the Rectum: Report of a Case

We describe herein a case of amelanotic melanoma of the rectum. Macroscopically, the tumor was lacking in pigmentation and microscopically, it was found to be deficient in melanin. Moreover, the tumor cells showed positive staining for HMB-45, the antimelanoma antibody, which led to a diagnosis of amelanotic melanoma. The patient died of metastatic tumors in the liver and bone 17 months after undergoing abdominoperineal resection of the rectum and dissection of the bilateral inguinal lymph nodes. Received: June 12, 2000 / Accepted: January 9, 2001     

Ileal Malignant Melanoma Causing Intussusception: Report of a Case

Cutaneous malignant melanoma (MM) often metastasizes to the gastrointestinal (GI) tract; however, primary MM of the small intestine is a controversial diagnosis. We report the case of a 76-year-old woman found to have a primary MM in the ileum. After clinical evaluation, the radiological workup, which included magnetic resonance enteroclysis (MRE), revealed a large polypoid intraluminal tumor. She underwent laparotomy and the lesion was excised. Histological examination of the resected specimen revealed morphological and immunohistochemical characteristics of MM and a detailed postoperative examination failed to identify a primary lesion on the skin, anus, oculus, or any other site. The patient died of brain metastasis 6 months after surgery. According to our review of the literature, this is the first case of primary MM of the small intestine diagnosed with the help of MRE.     

Prognostic Indicators in Melanoma of the Vulva

Background: The aim of this study was to evaluate the prognostic significance of clinicalpathologic variables in melanoma of the vulva.Methods: From 1979 through 1995, 40 women with a diagnosis of vulvar melanoma underwent radical surgery. Patient age, tumor size and site, histologic type, ulceration, tumor thickness, lymph node status, and number of positive lymph nodes were assessed for prognostic significance by multivariate analysis.Results: Tumor thickness was a significant predictor of lymph node involvement, but not of survival. The most powerful predictors of survival by multivariate analysis were the lymph node status (P 5 .002) and the number of positive lymph nodes (P 5 .00003).Conclusions: The number of positive lymph nodes represents the strongest prognostic factor in melanoma of the vulva. Because of the lack of effective adjuvant therapies, such prognostic indicators might be used to define the timing and extent of the surgical approach.