SMALL BOWEL INTUSSUSCEPTION SECONDARY TO MALIGNANT MELANOMA 11 YEARS AFTER MELANOMA-IN-SITU EXCISION

Objectives: Small bowel is a well-described site of malignant melanoma; however, it is a rare cause of intussusception. We describe a case of jejunal intussusception secondary to small bowel metastasis from cutaneous melanoma 11 years after complete excision of melanoma-in-situ. A 68-year-old female was admitted to the hospital after acute worsening of a 6-month history of chronic abdominal pain. She also described associated nausea, vomiting, intermittent diarrhea, and anorexia. CT imaging was concerning for small bowel intussusception with a definite intraluminal lead point identified, concerning for small bowel mass. Given her acutely worsening symptoms and clear CT pathology, she was consented for exploration. Initial diagnostic laparoscopy was converted to laparotomy, and a palpable irregularity in the midjejunum was resected with 10 cm gross margins, and a primary jejunojejunostomy anastomosis was performed. She convalesced well and was discharged on postoperative day 2 tolerating a regular diet. Pathologic examination identified a 6.5 cm malignant melanoma with negative surgical margins and 15 negative lymph nodes. Of note, the patient underwent excisional biopsy of melanoma-in-situ 11 years prior to presentation, giving the consideration to this lesion as recurrent melanoma as opposed to a primary gastrointestinal malignancy. She subsequently underwent a PET-CT which identified a left thyroid nodule and T5 vertebral body. She underwent fine needle aspiration of the left thyroid nodule and is set to undergo left thyroid lobectomy for Bethesda III lesion. A thoracic spine MRI was unrevealing and will undergo serial imaging. Currently, she is receiving adjuvant pembrolizumab and is doing well postoperatively at 3-month follow-up. While malignant melanoma metastasizing to the GI tract is described, jejuno-jejunal intussusception is rarely encountered with melanoma as the lead point with few cases described in the literature. Even though the patient had a complete response from excision of remote melanoma-in-situ, suspicion for recurrent melanoma should always be raised in any patient with symptoms similar to our patient with any history of melanoma.

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