Abstract
The authors present a case of an 80-year-old Caucasian male with multiple gastric and rectal metastases from malignant melanoma presenting with hypochromic anemia as the sole symptom of disease without evidence of cutaneous and ocular tumor localization. The patient had a medical history positive for malignant lentigo melanoma of the occipital region of the scalp and early stage laryngeal squamous cell carcinoma and prostatic carcinoma treated with radiation therapy. The authors make some considerations on intestinal involvement by metastatic melanoma and discuss the choice of not treating with endoscopic procedures the gastric metastatic lesions most likely responsible for the clinical sign present at diagnosis. The patient was referred to clinical oncologists and received immunotherapy with ipilimumab and pembrolizumab.
Highlights
Metastatic involvement of the gastrointestinal tract by epithelial malignancies is a rather infrequent event as opposed to malignant melanoma, which appears to have a particular trend towards metastasis to the gut [1]
The objective of this paper is to present a case of an unusual clinical presentation of metastatic melanoma with hypochromic anemia refractory to iron therapy treated with endoscopic procedures and systemic immunotherapy
Occult gastrointestinal bleeding as the first clinical presentation of metastatic melanoma is relatively unusual, especially in the absence of other symptoms of disease
Summary
Metastatic involvement of the gastrointestinal tract by epithelial malignancies is a rather infrequent event as opposed to malignant melanoma, which appears to have a particular trend towards metastasis to the gut [1]. Autopsy series report up to 60% pathological intestinal involvement in patients that deceased once diagnosed with metastatic melanoma, which reaches clinical relevance in a median of 2% of patients only (range: 0.8–8.9%) [2, 3]. The wide range of incidences can be partly explained by difficulties in exploring the small intestine, which usually represents the most frequent localization of gastrointestinal metastasis, as well as the absence of specific symptoms which are more frequently reported in gastric and duodenal localization more accessible for diagnostic study [4]
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