JEJUNAL MELANOMA: A CASE REPORT

Case Presentation Patient C.E.C., 82 years old, with a history of melanoma removal in 2021 and no follow-up after the surgical procedure. She sought medical attention in October 2022 due to asthenia, black stools, and significant anemia (hemoglobin [hb] 6.2). She received two blood transfusions and underwent an upper digestive endoscopy (diagnosed with hiatal hernia and erythematous gastritis). She was discharged for outpatient follow-up after controlling the lower gastrointestinal bleeding. The patient did not attend follow-up visits and, in June 2023, returned to the emergency room with asthenia and melena, with a hemoglobin level of 6.9. She received two blood transfusions and underwent colonoscopy (diagnosed with colonic diverticulosis). She began follow-up with the coloproctology team in October 2023, where a scintigraphy was requested, detecting non-active gastrointestinal bleeding: intermittent bleeding in the projection of the small intestine (duodenum and jejunum). Surgical intervention was then requested. A proximal jejunal enterectomy was performed due to the identification of three tumor masses. The histopathological report confirmed nodular melanoma with necrosis signs in the mucosa, submucosa, and invasion of the muscularis propria. Fifteen mesenteric lymph nodes were dissected and the classification was TNM (AJCC 8th edition) pT2mpN0. Currently, the patient is undergoing oncology follow-up, diagnosed with skin melanoma with metastasis to the central nervous system, retroperitoneum, small intestine, and lungs.

Discussion Melanoma represents about one-third of metastatic neoplasms detected in the gastrointestinal tract, but it is diagnosed in only 1.5 to 4.4% of cases. Most cases are concentrated in the small intestine (60%), and metastases to solid organs occur in 55% of cases, predominantly in the liver (55%) and brain (45%). Around 60% of patients present with acute obstructive abdomen, 15% with perforative abdomen, 10% with epigastric pain and heartburn, 5% with intense abdominal pain, 5% with melena, and 5% with obstructive jaundice. Treatment of metastasis in hollow organs consists of excising the lesion. The survival after metastasis treatment ranges from 1 to 36 months.

Conclusion The prognosis for these patients is poor. According to the literature, survival is usually no more than 36 months. A thorough medical history is essential for early detection and intervention.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025