An unusual indication for central pancreatectomy--late pancreatic metastasis of ocular malignant melanoma.

Introduction: Pancreatic involvement in metastatic melanoma is not an uncommon feature in disseminated disease, but isolated metastasis to the pancreas is a rare entity. Management of the pancreatic metastatic melanoma is controversial and the role of surgery is poorly defined. Most of the resectable pancreatic metastases were treated by standard pancreatectomies, and the role of limited resections (as central pancreatectomy) was not yet established.

Case Report: A 43-years old woman with previously right eye enucleation for primary melanoma (4 years ago) developed three metastases (one located into the body of pancreas and two into the right inferior pulmonary lobe). The diagnosis of the pancreatic metastasis was done by endoscopic ultrasound -fine needle aspiration biopsy. A two step operation was performed: first a central pancreatectomy for pancreatic metastasis and after three weeks a right inferior pulmonary lobectomy for lung metastases.

Results: The postoperative outcome after central pancreatectomy was complicated by a bleeding from distal pancreatic stump, requiring a re-laparotomy for hemostasis and a pancreatic fistula conservatively treated. At 12 months after operation the patient is asymptomatic, with no clinical and imaging signs of recurrence.

Conclusion: Surgical resection remains the single hope for cure for patients with metastatic melanoma. Central pancreatectomy could be an optimal choice for metastatic malignant melanoma to the body of the pancreas only if a complete resection of the tumor can be achieved and can be accomplished by other surgical procedures for other sites of metastatic melanoma.