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J Surg Oncol. 2019 Jun;119(7):897-902. doi: 10.1002/jso.25393. Epub 2019 Feb 7.

Management of intussusception in patients with melanoma.

Author information

1
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
2
Division of Surgical Oncology, Emory University, Atlanta, Georgia.
3
Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, Oregon.
4
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland.
5
Division of Plastic Surgery, Department of Surgery, Yale University, New Haven, Connecticut.

Abstract

BACKGROUND:

Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception.

METHODS:

We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded.

RESULTS:

We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum).

CONCLUSION:

Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

KEYWORDS:

bowel resection; intussusception; melanoma; metastatic melanoma, surgery

PMID:
30734297
DOI:
10.1002/jso.25393
[Indexed for MEDLINE]

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