Atrium Health Wake Forest Baptist Winston-Salem, NC
Danielle Rambuss, MD, Abigail Ellington, MD, Victoria A. Margolis, MD, Sarah Barbina, MD, Darius A. Jahann, MD Atrium Health Wake Forest Baptist, Winston-Salem, NC Introduction: Melanoma is known to metastasize to almost any organ system; most commonly to the lungs, liver, and brain. We present a patient with a prior diagnosis of pT2a pN0 cM0 melanoma status post resection with positive margins who presented with progressive right upper quadrant (RUQ) pain, found to have a malignant biliary obstruction.
Case Description/
Methods: A 50-year-old male with a history of cutaneous melanoma status post resection 3 years prior presented with RUQ abdominal pain, nausea, vomiting, and weight loss. A RUQ ultrasound was significant for cholelithiasis but was otherwise unremarkable. As his symptoms continued, there was concern for biliary cholic, and he underwent a cholecystectomy. Shortly after, the patient developed jaundice and severe pruritus. Laboratory workup was remarkable for total bilirubin 9.1 mg/dL. Computed Tomography (CT) scan demonstrated a heterogeneous 5.6x4.8cm mass within the liver hilum, which caused upstream dilation of the proximal common bile duct and intrahepatic bile ducts as well as paraaortic and interaortocaval lymphadenopathy. He underwent EUS with fine needle biopsy (FNB) of a lymph node and ERCP, which showed a 15mm common hepatic duct stricture with upstream dilation concerning for malignancy. Wire-guided balloon dilation to 4mm and placement of a 10Fr x 12cm transpapillary plastic biliary stent was pursued with subsequent spontaneous biliary drainage. Pathology from the prior cholecystectomy and FNB was consistent with metastatic melanoma. He was discharged with a medical oncology referral. Discussion: In one post-mortem review, very few patients with metastatic melanoma had gallbladder and biliary tree involvement, 15% and 6%, respectively. Symptomatic metastatic melanoma to the biliary tree is even more rare, and therefore, there are limited recommendations regarding management. Biliary stenting has been shown to have some palliation benefits. In cases without concurrent metastasis, it is reasonable to consider surgical resection. Despite treatment options, metastatic melanoma to visceral sites has a median survival time of 4-9 months. The utility of chemotherapy and immunotherapy is understudied in this rare presentation of melanoma. However, the most recent data on metastatic melanoma has shown promising response rates with immune checkpoint inhibitors and targeted therapy. While rare, metastatic melanoma masquerading as obstructive jaundice is an important differential to consider in the right clinical context.
Disclosures: Danielle Rambuss indicated no relevant financial relationships. Abigail Ellington indicated no relevant financial relationships. Victoria Margolis indicated no relevant financial relationships. Sarah Barbina indicated no relevant financial relationships. Darius Jahann indicated no relevant financial relationships.
Danielle Rambuss, MD, Abigail Ellington, MD, Victoria A. Margolis, MD, Sarah Barbina, MD, Darius A. Jahann, MD. P2274 - Beyond the Skin: Melanoma’s Hidden Path to the Biliary Tree, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
