Sir,

Pancreatic metastases from primary cutaneous melanoma are rare, in the order of 2–5%, exceptionally diagnosed when the patient is alive. Herein, we report two new observations.

A 66-year-old patient, followed for a right plantar acrolentiginous melanoma at the metastatic stage at the lymph node and pulmonary level, was readmitted in a picture of cholestatic jaundice and clinical aggravation (Figs. 1a and 1b). A cerebro-cervical-thoraco-abdomino-pelvic CT scan revealed a tissue mass of the head of the pancreas measuring 65 x 50 mm (Fig. 2). The diagnosis of a secondary location was confirmed by the radiologists. Given his multivisceral involvement, the patient was referred to oncology for further management.

	Figure 1: a) Frank cholestatic icterus. b) Plantar ulcerative tumor.
	Figure 2: Abdominal CT scan revealing a tissue mass of the pancreatic head.

A 57-year-old patient, followed for a right plantar acrolentiginous melanoma at the metastatic stage (Fig. 3), having benefited from a lymph node curage with chemotherapy, was readmitted for clinical worsening and installation of new skin metastases. A cerebro-cervical-thoraco-abdominopelvic CT scan revealed a tumor of the head of the pancreas measuring 48 mm, associated with other secondary pulmonary and adrenal localizations. The patient was lost to follow-up.

Figure 3: Plantar ulcerative tumor.

Melanoma usually metastasizes to the lymph nodes, liver, lungs, or brain. Pancreatic metastases are rare, occurring between 2% and 5%, with 76 cases having been described in the literature [1]. Most come from the kidney, lung, or breast [2]. They present with cholestatic jaundice, abdominal pain, and weight loss. Endoscopy is indicated for gastrointestinal symptoms.

Eighty-five percent of pancreatic metastases are incidentally discovered on imaging at an inoperable advanced stage [3]. The choice of treatment should take into account life expectancy, the performance index of the WHO, and the number of metastases. For multivisceral involvement, surgery remains a palliative treatment to relieve symptoms and improve quality of life [3]. Melanoma remains an aggressive malignancy due to its rapid and significant metastatic potential. Although pancreatic metastases are rare, early diagnosis by imaging is crucial.

REFERENCES

1.  Nakamura Y, Yamada R, Kaneko M, Naota H, Fujimura Y, Tabata M, et al. Isolated pancreatic metastasis from malignant melanoma:A case report and literature review. Clin J Gastroenterol. 2019;12:626-36.

2.  Chikhladze S, Lederer AK, Kühlbrey CM, Hipp J, Sick O, Fichtner-Feigl S, et al. Curative-intent pancreas resection for pancreatic metastases:Surgical and oncological results. Clin Exp Metastasis. 2020;37:313-24.

3.  Kochhar R, Ali H, Mak S, Manoharan P. Metastatic cutaneous malignant melanoma:Spectrum of imaging findings and the role of multimodality imaging. J Med Imaging Radiat Oncol. 2009;53:467-78.