Supplementary Material for: Trocar site recurrence after laparoscopic cholecystectomy for unsuspected isolated gallbladder metastasis of melanoma: a case report and review of the literature

Cutaneous melanoma can metastasize to almost any organ, including in-transit metastases, lymph nodes, liver, lungs, brain, and bones. Spread to the gastrointestinal tract is less common and generally concerns the small bowel, colon, and stomach. Gallbladder involvement is rarer and only few cases describe it as the sole site of metastasis upon diagnosis. Melanoma metastases to the gallbladder are usually detected on staging or surveillance imaging, as patients usually show few or no symptoms. In resectable stage IV melanoma patients, complete surgical resection appears to improve the prognosis. However, due to the rarity of isolated gallbladder metastasis of melanoma, there are no guidelines regarding the optimal surgical approach (endoscopic or open cholecystectomy). Here, we report the case of isolated gallbladder melanoma metastasis found after laparoscopic cholecystectomy performed in a 46-year-old female patient with no known history of cancer presenting with acute cholecystitis symptoms. Six weeks after surgery, the patient developed trocar site recurrence. This case highlights the importance of a planned and open surgery for resectable melanoma metastases rather than a laparoscopic approach.

皮肤黑色素瘤（cutaneous melanoma）可转移至几乎所有器官，包括移行转移（in-transit metastases）、淋巴结、肝脏、肺脏、脑组织及骨骼。胃肠道转移相对少见，通常累及小肠、结肠与胃。胆囊受累的情况更为罕见，仅少数病例报道其为诊断时唯一的转移部位。胆囊黑色素瘤转移通常在肿瘤分期检查或随访影像学检查中被检出，此类患者往往症状轻微或无明显临床症状。对于可切除的IV期黑色素瘤患者，根治性手术切除似乎可改善其预后。但由于孤立性胆囊黑色素瘤转移极为罕见，目前尚无关于最佳手术方式（内镜胆囊切除术或开腹胆囊切除术）的临床指南。本文报道1例病例：一名无已知恶性肿瘤病史的46岁女性患者因急性胆囊炎症状接受腹腔镜胆囊切除术，术后发现孤立性胆囊黑色素瘤转移。术后六周，患者出现穿刺孔复发。该病例凸显了对于可切除黑色素瘤转移灶，采用计划性开腹手术而非腹腔镜术式的临床重要性。