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The evolving landscape in the management of gastric metastases from melanoma: a case series

Sabino Strippoli, Eustachio Ruggeri, Livia Fucci, Ruggero Filannino, Antonella Cristofano, Andrea Armenio, Michele Traversa, Federica De Luca, Ondina Popescu, Francesco Macina and Michele Guida*

Background: The stomach is a very unusual site of metastasis from melanoma. Due to the few reports, we collected a case series in order to focus their endoscopic, clinical and biological features and to explore the therapeutic outcomes.
Methods: We collected 9 consecutive cases of gastric localization of metastatic melanoma. Results: All patients presented a long, nonspecific and vague history of gastric symptoms often cured as gastritis. The endoscopic features included multiple smooth black spots, ulcerated polypoid lesions or a wide neoplastic infiltration. BRAF status was mutated in only 1 patient while an NRAS mutation was found in 3 cases. Palliative gastrectomy was performed in 4 of 9 patients resulting in a good control of symptoms. The median survival in patients underwent gastrectomy was 25 months vs 4 months in non-surgically treated patients. Conclusions: We emphasize that physicians should be aware of the possible gastric involvement in patients with a history of melanoma and should suggest to promptly perform an endoscopic evaluation in symptomatic patients. Gastrectomy should be offered to all patients for palliative intent and to allow to plan systemic therapies recently enhanced with new and more effective drugs.