Multiple ulcerated submucosal masses in the gastrointestinal tract: a rare presentation of metastatic cutaneous malignant melanoma

 

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Malignant melanoma is the most common metastatic tumor of the gastrointestinal (GI) tract [1]; it is rarely a primary tumor in the GI tract. Malignant melanoma is more frequently identified in the anus and rectum (31% and 22%, respectively), but it can also be found in the esophagus (6%), stomach (3%), small intestine (2%), and large intestine (1%), as well as in the oronasopharynx (35%) [2].

We report the case of a 71-year-old woman with a history of nodular malignant melanoma of the right leg, which had been surgically resected 3 years previously. She presented to us with an episode of upper GI bleeding, with melena and hematemesis. Laboratory tests showed a hemoglobin of 6.6 g/dL with a mean cell volume (MCV) of 75 fL, and an albumin of 3.2 mg/dL; liver function tests and coagulation tests were normal. An upper GI endoscopy was performed, and multiple gastric ulcerated submucosal masses were found ([Fig. 1]), in addition to other nodular lesions on the posterior aspect of the duodenal bulb and in the esophageal introitus ([Fig. 2]). We decided to perform endoscopic mucosal resection (EMR) of one of the gastric masses ([Fig. 3]; [Video 1]). A lesion with similar features was later found at the ileocecal valve during a colonoscopy ([Fig. 4]). Histology showed that all of the lesions were malignant epithelioid neoplasms with atypia; immunohistochemical analyses showed positivity for S100(+) and Melan A(+), which is compatible with metastatic malignant melanoma ([Fig. 5])

Nowadays, it is essential to consider that malignant melanoma is the most common metastatic tumor of the GI tract. Endoscopically, melanoma metastases to the stomach are classified into three types: ulcerated melanotic nodules on normal rugae; ulcerated submucosal masses; and pigmented mass lesions with necrosis [1] [3] [4]. In this case, the lesions found corresponded with the second type. In conclusion, this case demonstrates a rare presentation of metastatic melanoma, because it was affecting the entire GI tract. It is essential to consider these types of lesions as part of the spectrum of malignant melanoma. They are sometimes asymptomatic but unfortunately the prognosis is quite gloomy if they are found.

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Publication History

Article published online:
01 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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