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Serrao EM, Costa AM, Ferreira S, McMorran V, Cargill E, Hough C, Shaw AS, O'Carrigan B, Parkinson CA, Corrie PG, Sadler TJ. The different faces of metastatic melanoma in the gastrointestinal tract. Insights Imaging 2022; 13:161. [PMID: 36195726 PMCID: PMC9532488 DOI: 10.1186/s13244-022-01294-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Melanoma is the most aggressive form of skin cancer, with tendency to spread to any organ of the human body, including the gastrointestinal tract (GIT). The diagnosis of metastases to the GIT can be difficult, as they may be clinically silent for somewhile and may occur years after the initial melanoma diagnosis. CT imaging remains the standard modality for staging and surveillance of melanoma patients, and in most cases, it will be the first imaging modality to identify GIT lesions. However, interpretation of CT studies in patients with melanoma can be challenging as lesions may be subtle and random in distribution, as well as sometimes mimicking other conditions. Even so, early diagnosis of GIT metastases is critical to avoid emergency hospitalisations, whilst surgical intervention can be curative in some cases. In this review, we illustrate the various imaging presentations of melanoma metastases within the GIT, discuss the clinical aspects and offer advice on investigation and management. We offer tips intended to aid radiologists in their diagnostic skills and interpretation of melanoma imaging scans.
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Affiliation(s)
- Eva Mendes Serrao
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Department of Radiology, University of Cambridge, Box 218, Cambridge, CB2 0QQ, UK.
| | - Ana Maria Costa
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Sergio Ferreira
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Victoria McMorran
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Cargill
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Hough
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brent O'Carrigan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christine A Parkinson
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Primary Gastric Malignant Melanoma in a 68-Year-Old Woman: A Case Report and Review of the Literature. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:128-134. [PMID: 35911930 PMCID: PMC9289592 DOI: 10.12865/chsj.48.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
Abstract
Non-cutaneous melanoma is a very rare clinical entity. Gastric melanoma can be primary or secondary, but determining their nature is in most cases very challenging. To date, very few cases of primary gastric melanoma have been described in the literature. We report the first case of primary gastric melanoma documented in a Romanian patient, confirmed through clinical, imagistic, and pathological diagnosis. A 68-year-old female patient presented to our hospital with complaints of dyspepsia, abdominal pain, and weight loss. Esophagogastroduodenoscopy revealed two large sessile masses in the gastric fundus, which was histologically compatible with melanoma; immunohistochemistry staining was positive for vimentin, S100 protein, HMB45 antibody and Melan A/MART1, and negative for pan-CKAE1/AE3, leukocyte common antigen and DOG1. Extensive dermatological and ophthalmological examinations did not identify a primary lesion. The patient was therefore diagnosed with primary melanoma of the stomach. At the time of the diagnosis, multiple bone and pulmonary metastases were detected and considering the poor general status of the patient, surgery was not recommended. She died three months following diagnosis. A review of the literature identified only 32 other reported cases of primary gastric melanoma, all in individuals ≥50 years of age and most of them in male patients. Partial or total gastrectomy was the usual treatment of choice, but prognosis was overall poor. Awareness of this rare condition must be increased among healthcare providers, as early detection can improve survival chances.
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Mellotte GS, Sabu D, O’Reilly M, McDermott R, O’Connor A, Ryan BM. The challenge of primary gastric melanoma: a systematic review. Melanoma Manag 2020; 7:MMT51. [PMID: 33318781 PMCID: PMC7724652 DOI: 10.2217/mmt-2020-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
AIM Primary gastric melanoma is a rare clinical presentation. The purpose of this review was to compare the 1-year survival in patients who underwent surgery with patients who did not receive treatment. PATIENTS & METHODS A systematic search of databases for case reports and case series of primary gastric melanoma was conducted. RESULTS The mean survival of patients was 22 months. One-year survival was 56.5% with surgery, rising to 66% with adjuvant therapy. Mean survival of the surgical group was 21.05 months (±20.2) versus 4.5 months (±3.61) in the nonsurgical group. CONCLUSION Primary gastric melanoma has a poor prognosis but early surgical intervention can have a significant impact on patient outcome. We reviewed the biology and clinical diagnosis of gastrointestinal melanoma and the current management options available.
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Affiliation(s)
- Gregory S Mellotte
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
- Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Diya Sabu
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Mary O’Reilly
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Ray McDermott
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Anthony O’Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
- Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Barbara M Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
- Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
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Zechariah P, Surendran S, Abraham V, Samarasam I. Primary malignant melanoma of the stomach: a rare entity. BMJ Case Rep 2020; 13:13/9/e234830. [PMID: 32912884 DOI: 10.1136/bcr-2020-234830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 54-year-old man presented with easy fatiguability, dyspnoea on exertion and dyspeptic symptoms. On evaluation, he was found to have an ulcero-proliferative growth in the gastric fundus, the biopsy of which was malignant melanoma of the stomach. Further evaluation with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan showed operable disease with no focus of disease elsewhere. He was diagnosed as primary gastric melanoma and underwent radical total gastrectomy with adequate margins. His postoperative period was uneventful. Further adjuvant therapy was refused by the patient. At 6-month follow-up, an 18F-FDG PET-CT scan was done, which showed no evidence of disease. On follow-up at 1-year, he was alive and asymptomatic.
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Affiliation(s)
- Pradeep Zechariah
- Department of General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Surendran
- Department of General Surgery Unit III and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vijay Abraham
- Department of General Surgery Unit III and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Inian Samarasam
- Department of General Surgery Unit III and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Schizas D, Tomara N, Katsaros I, Sakellariou S, Machairas N, Paspala A, Tsilimigras DI, Papanikolaou IS, Mantas D. Primary gastric melanoma in adult population: a systematic review of the literature. ANZ J Surg 2020; 91:269-275. [PMID: 32687691 DOI: 10.1111/ans.16160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary gastric melanoma (PGM) is a rare malignant tumour of the stomach with poor prognosis. The aim of this systematic review was to assess the available literature on this entity and to highlight its biological behaviour and preferred treatment approach. METHODS PubMed and Cochrane bibliographical databases were independently searched (last search: 2 February 2020) by two investigators for articles reporting on PGM in the adult population. RESULTS Twenty-five studies met the inclusion criteria and concerned collectively 25 patients (18 males and seven females) with an age of 63.4 ± 8.97 years (mean ± standard deviation). Main symptoms included abdominal pain (64%), weight loss (48%) and hematemesis or melena (32%). The most frequent tumour location was the body of the stomach (54.2%). All tumours were surgically resected and the majority of the patients had a partial gastrectomy (52%). Median recurrence time was 5 months and 12% of patients reached 5-year survival landmark. CONCLUSION PGM is a rare disease characterized by an aggressive malignant behaviour. Its differential diagnosis from a metastatic lesion is crucial. A prompt diagnosis and therapeutic approach are needed. Further studies are required to elucidate the optimal management of this clinical entity.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nefeli Tomara
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free London, London, UK
| | - Anna Paspala
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Mantas
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Khosla D, Zaheer S, Periasamy K, Rana S, Madan R, Gude G, Vasishta R, Kapoor R. Primary malignant melanoma of the stomach: A rare neoplasm. CLINICAL CANCER INVESTIGATION JOURNAL 2020; 9:216. [DOI: 10.4103/ccij.ccij_77_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wang J, Yang F, Ao WQ, Liu C, Zhang WM, Xu FY. Primary gastric melanoma: A case report with imaging findings and 5-year follow-up. World J Gastroenterol 2019; 25:6571-6578. [PMID: 31802836 PMCID: PMC6886020 DOI: 10.3748/wjg.v25.i44.6571] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most melanomas identified in the stomach are metastatic; primary gastric melanoma (PGM) is extremely rare, and the relevant studies are relatively scarce. PGM may be incorrectly diagnosed as other gastric malignant tumor types.
CASE SUMMARY We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis. A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain. Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia. Computed tomography (CT) revealed a heterogeneous tumor with uneven enhancement. Enlarged lymph nodes were noted in the lesser curvature of the stomach. On magnetic resonance imaging (MRI), T1- and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor, respectively, both of which increased substantially after uneven enhancement. Near total gastrectomy was performed, and the tumor was pathologically confirmed to be a gastric melanoma. Because no other possible primary site of malignant melanoma was suspected, a clinical diagnosis of PGM was made. The patient was followed for nearly 5 years, during which she received CT reexamination, but no recurrence or metastasis was observed.
CONCLUSION Certain imaging characteristics could be revealed in PGM. Imaging examination can be of great value in preoperative diagnosis, differential diagnosis, and follow-up of patients with PGM.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Fang Yang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Wei-Qun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Chang Liu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wen-Ming Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Fang-Yi Xu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Hatano Y, Haruma K, Ayaki M, Kamada T, Ohtani H, Murao T, Manabe N, Mori H, Masaki T, Shiotani A. Black Spot, a Novel Gastric Finding Potentially Induced by Proton Pump Inhibitors. Intern Med 2016; 55:3079-3084. [PMID: 27803398 PMCID: PMC5140853 DOI: 10.2169/internalmedicine.55.6974] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/27/2016] [Indexed: 12/17/2022] Open
Abstract
Objective We have recently discovered new gastric lesions with black spots. There have been no reports about black spots and their clinicopathological features. We therefore report the clinicopathological features of black spots and assess their causes and mechanisms. Methods Sixty-four patients with black spots among 26,620 Japanese patients that underwent endoscopy between May 2012 and October 2014 were enrolled. Endoscopic findings of black spots were defined as black pigmentations in the gastric mucosa by conventional endoscopy. We investigated the clinicopathological characteristics, including gender, age, underlying diseases and medications, endoscopic and pathologic findings of patients with black spots. Results The prevalence of patients with black spots was 0.24%. Of sixty-four cases, 44 (68.8%) were taking proton pump inhibitors (PPIs). Eight (12.5%) were taking corticosteroids. There were 10 cases (15.6%) with decreased renal function. All black spots were identified only in the fundic gland region. Forty-one (64.1%) patients had multiple (more than ten) black spots. There were two different types: black spots on the flat mucosa and black spots on fundic gland polyps. Pathologically, parietal cell protrusions, fundic gland cysts and brownish pigmentation in fundic gland cysts were seen in 26 (76.5%), 23 (67.6%) and 6 (17.6%) patients, respectively. Conclusion We herein describe gastric black spots as a new gastric mucosal finding that arises only in the fundic gland region. The black spots are pathologically brownish pigmentations in fundic gland cysts. Adverse events of PPIs and parietal cell protrusion caused by PPI use are strongly considered to be one of the etiologies of black spots.
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Affiliation(s)
- Yu Hatano
- Department of Internal Medicine, Mitsugi General Hospital, Japan
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Augustyn A, de Leon ED, Yopp AC. Primary gastric melanoma: case report of a rare malignancy. Rare Tumors 2015; 7:5683. [PMID: 25918612 PMCID: PMC4387358 DOI: 10.4081/rt.2015.5683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/25/2015] [Accepted: 01/30/2015] [Indexed: 12/20/2022] Open
Abstract
We report the case of a 64-year-old white male who presented to his primary care physician with complaints of fatigue. Physical exam was unremarkable and laboratory studies revealed profound anemia, for which the patient received a transfusion. Esophagogastroduodenoscopy revealed a bleeding mass in the proximal stomach that was histologically determined to be malignant melanoma, with immunohistochemical staining demonstrating positivity for SOX10, S100, MART-1, and HMG-45. After an extensive dermatological exam no other primary lesion was identified. Whole body positron emission tomography (18-FDG-PET/CT) demonstrated pathologic uptake only in the area of the proximal stomach. For this reason, primary gastric melanoma was suspected in this patient. The patient underwent subtotal gastrectomy with mass excision followed by Roux-en-Y reconstruction. Very few cases of primary gastric melanoma have been reported. We report this case and present diagnostic criteria for primary non-cutaneous melanoma and discuss potential non-surgical therapies.
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Affiliation(s)
- Alexander Augustyn
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Emma Diaz de Leon
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Adam C Yopp
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Division of Surgical Oncology, University of Texas Southwestern Medical Center , Dallas, TX, USA
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Cho JM, Lee CM, Jang YJ, Park SS, Park SH, Kim SJ, Mok YJ, Kim CS, Lee JH, Kim JH. Primary gastric malignant melanoma mimicking adenocarcinoma. J Gastric Cancer 2015; 14:279-83. [PMID: 25580362 PMCID: PMC4286909 DOI: 10.5230/jgc.2014.14.4.279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.
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Affiliation(s)
- Jun-Min Cho
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - You-Jin Jang
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung-Soo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung-Joo Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young-Jae Mok
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chong-Suk Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Slater JM, Ling TC, Slater JD, Yang GY. Palliative radiation therapy for primary gastric melanoma. J Gastrointest Oncol 2014; 5:E22-6. [PMID: 24490048 DOI: 10.3978/j.issn.2078-6891.2013.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/20/2013] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Primary gastric melanoma is an exceedingly rare cause of upper gastrointestinal bleeding (GI bleeding). Prior reports of primary gastric melanoma have mostly been treated with surgery with utilization of radiation therapy being unreported. Radiation therapy has been used to palliate bleeding of other cancers including lung, bladder, cervix, and more recently primary gastric cancers. CASE PRESENTATION This case documents an 87-year-old male who presented with fatigue and melena, and was found to have severe anemia. Endoscopy with biopsy revealed an isolated focus of melanoma. After discharge, he presented two days later and was found to have continued bleeding. Because he was deemed a poor surgical candidate he elected to undergo palliative radiation therapy for bleeding control. DISCUSSION The diagnosis of primary verses metastatic melanoma is a topic of debate. Case reports of patients with no known extra-gastric primary have undergone surgical treatment with varying outcomes. Patients with metastatic gastric melanoma have relied on chemotherapy and radiation in addition to surgery, with radiation being used in the palliative setting. The use of radiation to control bleeding in other cancers including primary gastric adenocarcinoma has been previously studied. This case documents the utilization of radiation therapy in bleeding due to primary gastric melanoma. CONCLUSIONS Radiation therapy can provide adequate bleeding palliation in patients with primary gastric melanoma.
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Affiliation(s)
- Jason M Slater
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Ted C Ling
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Jerry D Slater
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Gary Y Yang
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
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