METASTATIC MELANOMA OF THE STOMACH Melanoma metastático do estômago

Metastatic melanoma of the stomach is a relatively rare entity of unusual diagnostic during life. Most studies have pointed out that only 2% to 4% of the patients with metastasis of the gastrointestinal tract melanoma are diagnosed during the course of the disease12. However, necropsy studies have shown that about 60% of the patients who die of melanoma present gastrointestinal metastasis5,11. The delay in the appearance of symptoms and their duration prior to the diagnosis contribute to these factors. The most common clinical picture presented by patients with gastrointestinal melanoma includes anemia, abdominal pain, apparent or occult digestive bleeding, weight loss and abdominal mass1. Yet, the most common sites of the gastrointestinal metastasis are small bowel (35%-67%), colon (9%-15%) and stomach (5%-7%)12,10. Several studies have shown that surgery is a good option in these cases, once in addition to presenting low morbidity (8.8%) and mortality (2.9%), it relieves the symptoms in over 90% of the cases and increases the long-term survival of the patients who undergo surgical resection with curative purpose.1 Frequently, the surgeries are performed under emergency conditions and the indications, in these situations, include bleeding or anemia, obstruction, abdominal pain and intestinal perfuration8. Regarding the prognosis, the patients subjected to a curative resection have a mean survival of 48,9 months, while those with palliative resection survive a mean of 5,4 months10. In the long-term survival, the two most important prognostic factors are the surgical resection with curative purpose and the initial site of the distant metastasis being in the gastrointestinal tract10. A case of metastatic melanoma of the stomach has been described as the third site of distant metastasis, subjected to curative resections evolving without signs of residual disease.