Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.205
Peer-review started: November 5, 2022
First decision: November 23, 2022
Revised: November 24, 2022
Accepted: December 13, 2022
Article in press: December 13, 2022
Published online: January 15, 2023
Processing time: 66 Days and 3.6 Hours
Melanoma is the most aggressive form of skin cancer, with a tendency to metastasize to any organ. Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide. Small intestine cancers especially small intestine metastases are relatively rare. Small intestine metastases are seldom described and likely underdiagnosed. Intussusception is most common in pediatric age, and in adults are almost 5% of all cases.
A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital, complaining of intermittent melena for 1 mo. Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass, indicating a neoplastic lesion with jejunojejunal intussusception. The patient underwent partial small bowel resection. Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma. The patient refused further anti-tumor treatment after the surgery. Ten months after the first surgery, the patient presented with melena again. Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall, and routine conservative treatment was given. Three months later, the patient developed melena again. The patient underwent a second surgery, and multiple metastatic melanoma lesions were found. The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.
Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.
Core Tip: Malignant melanoma is one of the most aggressive forms of skin cancer, with a high metastatic potential and poor prognosis. We report a patient who presented with intermittent melena and history of acral malignant melanoma. Abdominal imaging showed a neoplastic lesion of the small intestine with intussusception formation. Postoperative pathology confirmed small intestine metastatic melanoma. The patient refused further comprehensive treatment including immunotherapy and chemotherapy and experienced disease relapse 1 year later. The patient underwent a second surgery, which revealed multiple small intestine metastatic melanoma lesions. The patient was alive at last follow-up without receiving adjuvant anti-tumor therapy.