Rare clinical experiences for surgical treatment of melanoma with osseous metastases in Taiwan

Abstract

Background: Malignant melanoma occurs infrequently in Taiwan. Once it has progressed into osseous metastases, the prognosis is poor. There are no reported clinical experiences of surgical management in this area.

Methods: To improve our understanding of the rare clinical experiences, we retrospectively investigated clinical characteristics, radiological findings, treatment modalities, survival outcomes and prognoses of 11 Taiwanese patients with osseous metastasis of melanoma treated surgically at two national medical centers, National Taiwan University Hospital and National Cheng Kung University Hospital from January 1983 to December 2006.

Results: Six patients suffered from acral-lentiginous melanoma. Nine patients sustained multiple osseous metastases and most lesions were osteolytic. Nine patients also had sustained metastases to other organs including liver, lungs, lymph nodes, brain and spleen. Second malignancies including lung cancer, thyroid papillary carcinoma, renal cell carcinoma and cervical cancer co-existed in four patients. The interval from the initial diagnosis of melanoma to the clinical detection of osseous metastases varied from 0-37.8 months (mean 9.75 months). Metastatic melanoma was invariably fatal; the mean survival time from bone metastases to death was 5.67 months.

Conclusion: Due to the high morbidity and poor survival of Taiwanese patients with osseous metastases of melanoma, surgical treatment should be directed towards pain relief and the prevention of skeletal debilitation in order to maintain their quality of life.

Figure 1

Pathologic fracture of the right naviculum in a 51-year-old man with melanoma presented at the initial visit.

Figure 2

(a). Plain radiograph of a 74-year-old woman. The radiograph reveals a pathologic fracture at the diaphysis of the left tibia due to an osteolytic lesion in the medullary cavity. (b). T1-weighted magnetic resonance image showing several tibial lesions that are eccentric, oval and associated with clinically significant cortical erosion. (c). T1-weighted magnetic resonance image demonstrating a hypointense lesion with endosteal scalloping of the tibia and cortical erosion.

Figure 3

Magnetic resonance image of lumbosacral spine showing a compression fracture of L5 of posterior bulging contour with enhancement and epidural soft tissue mass over the anterior epidural space with marked compression of the thecal sac.