Laparoscopic Splenectomy for Massive Splenomegaly with Isolated Splenic Metastatic Melanoma

Usah Khrucharoen, MD; Yen-Yi Juo, MD; Thongsak Wongpongsalee, MD; Andrew Scott, MD; Erik P. Dutson, MD, FACS

Product Details
Product ID: ACS-5717
Year Produced: 2019
Length: 8 min.


In this video, we present a case of a 70 year-old patient with massive splenomegaly with increasing metastatic melanoma to the spleen who underwent laparoscopic splenectomy at our institution. Patient was diagnosed with malignant melanoma stage T3a on right ear lobe 15 years ago. He subsequently developed a recurrence and metastatic disease to the anterior and middle mediastinum, liver, spleen, and retroperitoneum. Two years ago, he appeared to have excellent response to nivolumab with resolution of metastatic disease. However, his recent PET/CT showed enlarging splenic mass metastasis with no other concurrent disease sites. Patient was offered surgical resection on this solitary metastasis with a combination immunotherapy trial. In selected patients with melanoma metastatic to intra-abdominal solid organs, complete surgical resection may improve overall survival. Patient successfully underwent laparoscopic splenectomy with uneventful postoperative course. Final pathology showed a 734-gram, 18.9 x 13.0 x 8.4 cm spleen with necrotic-appearing 12.2 x 5.5 cm and 0.5 x 0.5 cm nodules. Immunohistochemistry was positive for S100, MART1, HMB45, and SOX10, suggesting metastatic melanoma with treatment effect. All seven harvested lymph nodes were negative for malignancy (0/7). Patient was discharged on postoperative day 3 with oral pain medication and continuing monthly Nivolumab following complete resection.