Small Bowel Metastatic Melanoma: An Emblematic “Coal-Black” Appearance at Videocapsule Endoscopy

Alessia Todeschini,Alfredo Di Leo,Mariabeatrice Principi,Enzo Ierardi,Ilaria Loconte,Antonella Contaldo

doi:10.3390/medicina57121313

Alessia Todeschini, Alfredo Di Leo + Show 4 more

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https://doi.org/10.3390/medicina57121313

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Abstract

A 80-year-old woman underwent vulvar melanoma resection and segmental lung resection for pulmonary metastasis. Immunotherapy with Nivolumab was performed. One year later, the patient was admitted for gastrointestinal (GI) recurrent bleeding and severe anemia. Esophagoastroduodenoscopy and colonoscopy did not show any abnormality, while videocapsule endoscopy (VCE) revealed an irregular and exophytic whitish area with a “coal-black” central depression. Small bowel resection was performed and histological examination revealed S100 protein strongly positive melanoma metastasis. The patient died six months later from disease progression. A “coal-black” appearance of intestinal metastatic melanoma has been described only twice before this report. In one case the patient had been treated by immunotherapy with interferon A and dendritic cell-based vaccination. In our patient, it is presumable that the picture we observed was a consequence of Nivolumab treatment inducing the disappearance of melanocytes in the area surrounding the metastasis with the onset of the central coal-black lesion encircled by whitish tissue. This picture should be emblematic of intestinal metastatic melanoma in subjects treated with immunotherapy showing occult/obscure bleeding.

Highlights

Academic Editor: Rinaldo PellicanoReceived: 13 November 2021Accepted: November 2021Published: November 2021Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.Licensee MDPI, Basel, Switzerland.videocapsule endoscopy (VCE) is a non-invasive device, which allows investigating small bowel lesions, especially in patients with unexplained iron deficiency anemia and obscure/occult bleeding [1].Among potential sources of intestinal hemorrhage, cutaneous melanoma metastasis deserves a special mention
We aim to report the imaging series of the third case of a “coal-black” appearance of intestinal metastatic melanoma
A study enclosing 5129 VCE investigations showed that 66% of secondary small bowel tumors are melanomas [8]

Summary

Introduction

VCE is a non-invasive device, which allows investigating small bowel lesions, especially in patients with unexplained iron deficiency anemia and obscure/occult bleeding [1]. Among potential sources of intestinal hemorrhage, cutaneous melanoma metastasis deserves a special mention. Despite the GI tract being the most common site of metastastic localization of this tumor, symptomatic involvement is found only from 0.8%. GI bleeding, perforation and intestinal obstruction are the most frequent manifestations and VCE constitutes the most suitable diagnostic tool [3]. GI metastatic melanomas are classified as submucosa-like or primary carcinoma-like tumors and lesions may appear as ulcerated with or without signs of bleeding [4]. Smedegaard and Adamsen in 2007 firstly described a singular VCE picture of intestinal metastatic melanoma, i.e., a characteristic “coal-black”

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