文档介绍：ch 2008 Volume 6 Number 3
Issue Highlights
Photodynamic
Therapy for
Cholangiocarcinoma
Chronic Abdominal
Pain in Adolescents
Prognostic Factors in
Acute Liver Failure
Supplementation
Versus Dietary
Counseling in
Chronic Pancreatitis
Official Clinical Practice Journal of the
Image of the Month
Metastatic Malignant Melanoma of the Gastrointestinal Tract
KEELY R. PARISIAN,* JOEL E. MCFARLAND,‡ and ASHOK N. SHAH‡
*Department of Internal Medicine, and ‡Department of Gastroenterology, University of Rochester Medical Center, Rochester, New York
75-year-old man with a history of malignant melanoma presented autopsies show gastrointestinal tract involvement in approximately 50% to
Awith fatigue and dyspnea for 4 months and melena in the setting 60% of patients with malignant melanoma; however, clinical diagnosis is
of increased nonsteroidal anti-inflammatory drug use over the past 7 made in only % of all patients with malignant Discourag-
days for knee pain. The patient first was found to have malignant ingly, many patients with resected metastatic melanoma will present with
melanoma of the right upper cheek and the right and left auricle in disease relapse years later. Several studies have reported relief of symptoms
2003, with a second occurrence in 2005 on the posterior neck diagnosed and prolonged survival with surgical resection in patients with localized or
on excision as Clark level IV with a Breslow depth of 6 mm. Sentinel moderate spread of disease. Patients with extensive metastasis and poor
lymph node mapping and a positron emission tomography scan were performance status are considered inoperable, as in the case that we have
negative for evidence of metastatic disease. He presented to our insti- presented here. Further, extraintestinal manifestations of disease have been
tution after an episode of presyncope. A review of systems was signifi- shown in 50% of patients who present with gastrointestinal tract