Recurrence of Stage IV Melanoma to the Spleen With Splenomegaly Treated With Laparoscopic Splenectomy
Source: American College of Surgeons, March 2023
Background
A male patient diagnosed with cutaneous malignant melanoma presented with oligometastasis to the spleen.
Summary
The patient is a 70-year-old male who presented with recurrent metastatic melanoma to the spleen. He was initially diagnosed with cutaneous malignant melanoma stage cT3aN0M0 on the right ear lobe . A year prior to presentation, he developed a recurrence at the primary site, and subsequently went on to develop metastatic disease to the right upper arm, anterior and middle mediastinum, liver, spleen, and retroperitoneum. The patient was treated with nivolumab and appeared to have an excellent response with complete resolution of metastatic disease, confirmed by whole-body PET/CT scan . The patient had a 12-month disease-free interval. The following year, his PET/CT scan showed an isolated splenic mass with increasing size and metabolic activity and associated splenomegaly. Following a multidisciplinary tumor board discussion, the consensus was to perform metastasectomy, and the patient subsequently underwent laparoscopic splenectomy followed by adjuvant systemic therapy. Final pathology showed metastatic melanoma with treatment effect with negative lymph nodes (0/7). A combination of metastasectomy and systemic therapy has been shown to improve overall survival in selected patients dramatically.
Conclusion
We present a rare case of recurrent isolated metastatic melanoma to the spleen treated with laparoscopic splenectomy. Metastasectomy in resectable disease can improve overall survival. Adjuvant systemic therapy is recommended following surgical resection.