Evaluation of the small bowel has drastically improved with the introduction of capsule endoscopy, which is helpful in identifying small bowel pathology. However, capsule endoscopy is limited as it doesn't allow biopsy or interventions. Double-balloon enteroscopy (DBE) is able to reach most abnormal areas seen on capsule endoscopy, and has the benefit of allowing diagnostic and therapeutic interventions. We report a case of metastatic melanoma initially diagnosed with biopsy of a small intestine mass during DBE. Case: A 73 year old man presented with 5 days of melena and hemoglobin (Hb) of 11.9g/dl, one month after having a normal physical exam, Hb, and screening colonoscopy. His bowel movement returned to normal and the bleeding appeared to have stopped, and no further evaluation was done. 8 weeks later he had another episode of melena and the Hb was 10.8 g/dl. Upper endoscopy showed antral gastritis and duodenitis, but no signs of bleeding. Capsule endoscopy showed bleeding in the distal small intestine, without a definite source. Physical exam was normal, except for hemoccult positive stool. Because capsule endoscopy suggested the bleeding source was in the distal small intestine, DBE was performed through the colon and ileocecal valve, using the Fujinon EN-450T5 system. 70cm proximal to the ileocecal valve a hemorrhagic mass (3–4 cm diameter) was identified. Biopsies were obtained, and showed a malignant neoplasm. Special stains were positive for S100 and HMB45, consistent with a metastatic melanoma. The patient underwent a laparoscopy with partial small bowel resection to remove the bleeding tumor. Despite careful skin examination, a primary lesion was not found. Staging evaluation showed other metastases in the liver, chest, bones, and brain. He was treated with chemotherapy. Discussion: Malignant melanoma involving the GI tract may be primary or metastatic, the latter being more common. Melanoma is the most common tumor with metastatic spread to the GI tract. Clinical presentation varies and can include bleeding, weight loss, obstruction, or malabsorption. In the past the diagnostic test of choice was enteroclysis, which is limited since histopathology can't be obtained and surgery would be the next step for definitive diagnosis. This case illustrates the usefulness of DBE in diagnosing small intestine pathology that is not accessible to conventional endoscopy.