Is pancreaticoduodenectomy justified for metastatic melanoma to the ampulla of Vater?

Abstract Background Metastatic melanoma to the ampulla of Vater is rare. The purpose of this study is to summarize the characteristics and outcomes of metastatic melanoma to the ampulla of Vater, and to highlight the impact of surgery on the prognosis of patients with metastatic melanoma. Methods The pooled data from a case encountered at our institution and all the sporadic cases published on PubMed and MEDLINE from 1996 to 2023 were included for analysis. Results A total of 14 cases of metastatic melanoma to the ampulla of Vater were recruited. Seventy-three percent of the primary melanomas were cutaneous type, and 27% mucosal type. The most common symptom was jaundice (86%). The size of metastatic melanoma to ampulla ranged from 1.5 cm to 8 cm, with a median of 2.75 cm. Concomitant metastasis to other organs occurred in 82% at the diagnosis of this tumor, most commonly to the brain, lungs, and liver (36% each, respectively). Among all the reported cases, pancreaticoduodenectomy was performed in five patients. The overall 1-year survival rate was 27.3%, with a median of 4 months. Wide excision of the primary lesion and chemotherapy significantly improve the survival rate (p = 0.048). There is a trend toward improved survival in those undergoing pancreaticoduodenectomy followed by chemotherapy. Conclusions Given the availability of effective systemic therapy, metastatic melanoma to the ampulla of Vater is not necessarily to preclude a major surgery.