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• W2912494597 abstract "Introduction: Melanoma, the most common tumor metastasizing to the GI tract found post-mortem, is rarely symptomatic. Similarly, this cutaneous malignancy is a rare etiology of severe, occult GI bleeding. We report a case of unexplained chronic anemia due to recurrent melanoma in the absence of other suggestive complaints. Case Report: A 70 year-old man with known melanoma diagnosed 3 years previously was sent to the emergency department after routine tests demonstrated severe anemia. Bloodwork was done to prepare for a duodenal biopsy after PET scan for routine metastatic surveillance demonstrated hyperactivity in the duodenum. He gave no history of trauma, bleeding, or GI complaints. Review of symptoms revealed mild fatigue and dyspnea on exertion of unclear duration. Physical exam: blood pressure = 152/90; pulse = 90/minute with minimal postural change. No skin lesions were present. The rest of the exam was unremarkable except stool was positive for occult blood. Hgb. was 6 gm% and iron studies were consistent with a microcytic, hypochromic anemia. Colonoscopy was normal. Upper endoscopy using a pediatric colonoscope demonstrated a 2–3 cm, pigmented, ulcerated mass in the distal duodenum- proximal jejunum. Histology: malignant melanoma. He was referred to medical oncology for treatment options. Discussion: Melanoma is an aggressive tumor; the GI tract is the second most common site of metastasis after the lung. An ante-mortem diagnosis is made in only 1.5% to 4.4% of patients. Diagnostic challenges include (1) small bowel recurrence as late as 21 years after resection of a primary skin lesion, (2) occurrence without a cutaneous site; (3) presentation as a non-pigmented lesion or mimicking a typical benign polyp; (4) non-specific symptoms suggestive of more common disorders. Endoscopically, small bowel lesions manifest as single or multiple mucosal or intramural nodules, ulcerated masses, or as diffuse bowel involvement. This patient underscores the need to consider recurrent, extra-cutaneous tumor in all individuals with a history of melanoma and evidence of GI bleeding of any magnitude. Such patients undergoing endoscopy should have all lesions biopsied to detect possible metastatic disease." @default.
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• W2912494597 date "2007-09-01" @default.
• W2912494597 modified "2023-10-16" @default.
• W2912494597 title "Severe Anemia as the Presenting Feature of Small Bowel Melanoma" @default.
• W2912494597 doi "https://doi.org/10.14309/00000434-200709002-00818" @default.
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