Mustafa SALIŞ, Eda KOÇAK, Esra ÖZKAN, Serdar TOKMAK
Eskisehir Medical Journal - 2026;7(3):306-309
Malignant melanoma is one of the most common cutaneous tumors that metastasizes to the gastrointestinal system. Although the small intestine is the most common site for gastrointestinal system metastases due to its rich vascular structure and chemotactic properties, these metastases often remain silent and are only detected in high rates (60%) in autopsy series. Clinically significant cases usually present with acute surgical conditions such as bleeding, obstruction, or perforation. A 73-year-old male patient presented with rectal bleeding. Physical examination revealed tachycardic (115/min) and pallor. Skin examination showed irregularly bordered hyperpigmented lesions under the right nipple and clavicle. Laboratory investigation revealed profound anemia (Hgb: 8.2 g/dL) and elevated lactate dehydrogenase (LDH) (540 U/L). Esophagogastroduodenoscopy and colonoscopy revealed no bleeding source in the patient. Abdominal computed tomography scan showed mass lesions at the level of small bowel segments. Emergency laparotomy was performed, and a bowel-related mass lesion extending beyond the serosa was detected 140 cm proximal to the ileocecal valve. The patient underwent segmental small bowel resection and anastomosis, and histopathological examination was reported as "Metastatic Malignant Melanoma." The patient was discharged on the 7th postoperative day with surgical healing and referred to the oncology outpatient clinic. Malignant melanoma is the most common carcinoma to metastasize to the gastrointestinal system after breast and lung cancer. The time elapsed between primary malignant melanoma and the appearance of gastrointestinal metastases is reported in the literature to be between 2 and 18 months. In these patients, diagnosis is usually made after the development of a disease-related complication. Metastases to the gastrointestinal system may appear at the time of primary diagnosis or as the first sign of recurrence years later. Given the non-specific nature of the clinical presentation and the wide range of differential diagnoses in gastrointestinal metastatic malignant melanoma, rapid selection and accurate interpretation of imaging methods are crucial for timely diagnosis. Malignant melanoma can present with small bowel metastasis even years after primary diagnosis. Small bowel metastasis should always be considered in patients with unexplained gastrointestinal bleeding or abdominal pain, a history of melanoma, or suspicious skin lesions. Surgical resection is the primary treatment method to prevent complications and improve quality of life, even in the metastatic stage.
