Surgical Oncology 1995; 4: 105-110 Gastrointestinal metastases from malignant melanoma N. RICANIADIS, M. M. KONSTADOULAKIS, D. WALSH* AND C. P. KARAKOUSIS Departments of Surgical Oncology and *Computer Center, Roswell Park Cancer Institute, Buffalo, New York 14263, USA Between 1980 and 1992, 68 patients with clinical indications of involvement of the gastrointestinal (GI) tract with metastatic melanoma were treated at Roswell Park Cancer Institute. Presenting symptoms were anaemia, abdominal pain, nausea and vomiting. Sites commonly involved were the small bowel (75%), the large intestine (25%), and the stomach (16%). Twenty-one patients were considered unsuitable for surgery; their median survival after diagnosis of GI metastases was 2.9 months. Forty- seven patients underwent abdominal surgery; effective palliation was achieved in most of them. Complete resection of GI metastases was accomplished in 47% of patients. The median survival after operation was 27.6 months for patients with complete resection of GI metastasis and no other disease, 5.1 months for patients with resection of involved GI tract and other metastases present, and 1.9 months for patients who had a by-pass procedure only. The 5-year survival for patients with complete resection of GI metastases and no other evidence of disease was 28.3%. The other groups had only 1-year survivors. Surgical intervention is justified on the basis of these findings, and extended palliation can be achieved in patients with complete resection of metastatic disease. Surgical Oncology 1995; 4: 105-110. Keywords: gastrointestinal metastases, malignant melanoma, management, survival. INTRODUCTION Clinically detected in only 4-8% of living patients with disseminated melanoma [1,2), gastrointestinal (GI) tract metastases remain a common site of haematogenous spread in patients who eventually develop disseminated disease. Autopsy series report multiple site involvement in 95% of patients who die of melanoma [3). GI tract involvement is reported in almost 60% [2); when liver and spleen are included, the incidence is 86.3% [4). The strictly palliative role of surgery in patients with GI metastasis from melanoma has been previously emphasized [5-10). However, certain patients can be given extensive palliation through resection of the localized metastatic lesions, with long-term survival being reported for carefully selected patients [11-18). Correspondence: C. Karakousis, MD, PhD, Surgical Oncology Department, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, New York 14263, USA. The purpose of this study was to investigate the role of surgical intervention in the clinical treatment of the melanoma patient with GI metastasis, and define the group of patients who would benefit the most from an aggressive approach of surgical resection. MATERIALS AND METHODS Between 1980 and 1992, 68 patients presented at Roswell Park Cancer Institute (RPCI) with clinical indications of involvement of the GI tract with metastatic melanoma (liver and spleen excluded). Their charts were reviewed and all data concerning the characteristics and treatment of their primary, stage at presentation of the primary, the metastatic pattern prior to onset of the GI symptoms, the presentation, diagnosis and treatment of GI metastases and follow-up were recorded and analysed. The American Joint Committee on Cancer staging system was used [19]. The patients were subdivided for statistical analyses into four ©1995 Blackwell Science Ltd 105