[Melanoma adrenal metastasis: report of 3 cases and literature review].

Objective: To investigate the clinical diagnosis, treatment and prognosis of melanoma adrenal metastasis.

Methods: A total of 48 cases of malignant melanoma from 1985 to 2007 were reviewed. And three cases of melanoma adrenal metastasis were analyzed. There were 2 males and 1 female with an age of 57, 70 and 83 years old respectively. Two cases had a history of cutaneous melanoma and another one suffered previously from anal melanoma. The disease-free interval to adrenal metastasis were 25, 37, 33 months respectively. Two presented with flank or abdominal discomfort and another one had adrenal metastasis on routine examination. The maximal diameters of metastasis were 5, 8 and 12 cm respectively. The CT value of adrenal metastasis had a range of 9 - 45 Hu in plain scan. And the maximal post-contrast value was 107.5 Hu.

Results: One patient with concurrent lymph node metastasis received non-operative therapy with interleukin-2. The other two cases underwent complete resection of melanoma metastasis. One received adrenalectomy via retroperitoneal laparoscopic approach while another patient with tumor thrombus in inferior vena cava underwent right adrenalectomy and extraction of tumor thrombus out of inferior vena cava in traditional open surgery. When contralateral adrenal metastasis of melanoma was found 6 months later, left adrenalectomy laparoscopically was performed. The patient who was managed non-operatively died of cachexia 6 months later. Two operated patients did not accept adjuvant therapy. One had multiple metastasis in 16 months and died at 21 months. Another was alive without recurrence or new metastasis at 30 months.

Conclusion: Melanoma metastasis to adrenal gland is rare and it generally has a poor prognosis. Patients with adrenal metastases from melanoma, either isolated or with a limited number of additional metastases, may achieve a survival benefit from surgical resection if all visible lesions are removed.