Lifesaving transarterial embolization using absorbable gelatin sponge particles for massive bleeding of ruptured metastatic hepatic melanoma

To the Editor:Melanoma is an aggressive malignant tumor that arises from melanocytic cells. It usually originates from the epithelial tissues of the skin, retina and anorectal canal. Melanoma is characterized by early metastases, even from thin primary tumors. The most common sites of distant metastasis are: skin, lung, brain, liver, bone and intestine. Liver involvement occurs in 14% to 20% of cases [1] , but the diagnosis is usually performed incidentally on imaging studies, since these lesions are seldom symptomatic. Rarely, metastatic hepatic melanoma can manifest as an acute condition of massive bleeding due to spontaneous rupture of one or more hepatic lesions, with disastrous outcomes for patients in most cases. In the current literature, very few cases of spontaneous rupture of metastatic hepatic melanoma have been reported, all with fatal outcomes [2–5] . Indeed, when such a condition occurs, prompt management and bleeding control strategies are essential for long-term survival of these patients.