Capsule endoscopy for management of small bowel melanoma-is it time yet?

摘要: The global burden of melanoma is increasing. Currently, 132,000 cases are diagnosed each year worldwide.1 In Australia, which has the highest incidence in world, more than 11,000 new every year.2 number doubled 20 years from 1986 to 2006.2 2007, a total 1,279 Australians died melanoma, making this cancer responsible for 3.2% all deaths.2 Overall, 1 19 will be with before age 85 years. risk higher among men women (1 15 vs 24, respectively).2 Melanoma now third most common form both Australian (behind prostate and colon cancer) breast cancer), comprises 10% cancers.2 It young (aged 15—44 years), it kills any other single cancer.2 Although makes up only 2.3% skin cancers, 75% deaths.2 In United States, about one as high but also been increasing over past 30 years.3,4 Between 1992 2004, rate diagnosis rose by 3.1% annually.5 An estimated 123,590 were States 2011, resulting 8,790 deaths.3 As adults States.6 Of particular concern rise seen aged 15—29 years, whom torso location tumor. This finding attributed high-risk tanning behaviors.7 10 times whites African Americans, Latinos, Asians, frequently fatal these ethnic groups.3,5 One American dies almost hour (every 62 minutes).3 European figures show an melanoma.8,9 rates have reported Scandinavia, where patients per 100,000 individuals year. due type population. The Mediterranean countries lower, at 5—7 year.10 Data Asia, Middle East, Africa limited indicate low areas.8 The developing depends on combination genetic environmental factors. A personal or family history increases significantly, does presence atypical numerous moles (more 50), immunosuppression, and/or cancers.3 Other factors that make likely include sun sensitivity (characterized sunburning easily, difficulty tanning, natural blond red hair color), excessive exposure, use booths; recreational exposure main reason rising particularly fair skin, who overall.1 Depletion ozone layer, its protective function filter ultraviolet radiation, may contributing melanoma. Estimates suggest decrease levels result additional 4,500 melanoma.1 Clinicians long recognized tumors spread parts body, tumor metastasize gastrointestinal (GI) tract. When GI tract, small bowel (SB) involved stomach colon.11-15 Primary SB extremely rare.16 case report Atiq coauthors adds previous reports involvement melanoma.17 Importantly, illustrates not symptomatic, lesions pigmented, lesion polypoid nature.18-20 case, pretest probability abnormality was since patient had indicators possible namely iron-deficiency anemia occult bleeding.16,21-23 Albert colleagues recently proposed algorithm detection melanoma.24 their open, mul-ticenter, prospective study, 390 stages screened bleeding using fecal blood testing (FOBT). Those positive FOBT underwent panendoscopy, including capsule endoscopy (CE). addition, stage IV disease (distant metastases) offered pan-endoscopy. Forty-nine (12.6%) evidence bleeding. Thirty-eight (77.6%) agreed undergo endoscopic evaluation. 28.6% then dropped significantly: 1.7% III (nodal involvement) 0% I/II disease. FOBT-positive alone, higher: 72.7% 14.3% patients, detected CE. Albert found independent, negative prognostic factor survival disease.24 The question always arises whether there clinical benefit Approximately 84% melanomas when they still localized. Treatment early generally successful, 5-year 98%.3 falls 62% 16% regional distant spread, respectively. Patients advanced involvement.24 Similarly, those secondary often metastases elsewhere.25 While prognosis group poor, studies shown complete resection metastatic can significantly improve provide effective palliation.14,15,22,23,26-28 reasoning applies disease, safe achieve prolonged remission.29 therefore recommended clinicians attempt identify symptomatic undergoing treatment “curative” intent. It reasonable hypothesize earlier could survival. mentioned literature review, CE superior modalities detecting tumors.17 Given metastases, would seem ideal diagnostic tool.11-15 We previously sensitive follow-through abdominal computed tomography (CT) melanoma.19 fludeoxyglucose positron emission tomography—CT scanning, although converse apply.18 In colleagues, retained.17 However, document surgery. Capsule retention possibility our series, passed spontaneously patients.18 Nevertheless, contraindication procedure, provided obstruction. At present, we recommend investigated if either unexplained symptoms signs, do end-stage preclude further found. Likewise, increased uptake abdomen PET-CT scan should These 2 investigations regarded complementary.