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Metastatic Malignant Melanoma

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Metastatic malignant melanoma in liver is rare but should be included in the differential diagnosis of any liver malignancy that appears to be metastatic (Note: secondary liver tumors are far more common than primary hepatic neoplasms). Ocular (uveal) melanomas have a biologic tendency to metastasize to the liver.

Liver metastases may appear several years after resection of the primary tumor. FNA smears will show pleomorphic cells with intranuclear inclusions, prominent nucleoli, and cytoplasmic melanin (absent in amelanotic melanomas). Immunohistochemistry is sensitive and specific for the diagnosis of metastatic melanoma. Useful markers include HMB-45, S-100 protein, MART-1, and tyrosinase.

Treatment: Due to the diffuse, miliary involvement of the liver, surgical therapy is usually not an option. However, since liver is often the sole metastatic site in 70% to 90% of cases, transarterial approaches have been utilized, including hepatic artery infusion chemotherapy, transarterial chemoembolization, and selective internal radiation therapy. About 50% of patients show tumor regression or disease stabilization.

The photograph shows metastatic melanoma in liver in a young female patient. Some nodules are amelanotic and others are heavily pigmented. Image copyright: pathorama.ch.

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