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RACS ASC 2026
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Case Report: Metastatic Melanoma in the Gallbladder - Surgical Consideration
Poster
Presentation Description

Institution: Sir Charles Gairdner Hospital - Western Australia, Australia

Metastatic melanoma most commonly involves the skin, lungs, liver, bone, and brain. Gastrointestinal involvement is recognised, though metastatic disease to the gallbladder is rare. With improving survival in the immunotherapy era, atypical metastatic patterns are increasingly encountered, posing new diagnostic and management challenges. An isolated gallbladder metastasis was identified during routine oncological surveillance in a 71-year-old man on PET-CT with previously controlled metastatic mucosal melanoma. Further characterisation with MRI demonstrated a gallbladder mass suspicious for a primary gallbladder malignancy (and less likely a metastasis from melanoma). This presented a surgical management dilemma; whether to treat this as a gallbladder primary malignancy (consider performing an up-front extended cholecystectomy (including limited segment 4B/5 resection & lymphadenectomy) or whether to perform a laparoscopic cholecystectomy with intraoperative frozen section assessment of the cystic duct margin. Elective laparoscopic cholecystectomy was carried out; frozen section demonstrated no malignant involvement, and further bile duct resection was not required. Definitive histopathology confirmed metastatic melanoma confined to the gallbladder with clear margins, therefore no hepatic resection was required. The postoperative course was uncomplicated. Subsequent surveillance imaging identified disease progression at extra-biliary sites and systemic immunotherapy was recommenced. Isolated gallbladder metastasis from melanoma, although rare, should be considered in patients with a history of melanoma who develop new FDG-avid gallbladder lesions. Performing an up-front extended cholecystectomy is not indicated for metastases confined to gallbladder and excised with clear margins. Multidisciplinary assessment and selective surgical intervention can provide definitive diagnosis and be safely integrated into modern melanoma management.
Presenters
Authors
Authors

Dr Narayani Mukerji - , Dr Ho-Cing Victor Yau - , Dr Adam Philipoff -