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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1814147
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Isolated Gastric Metastasis from Primary Nasal Mucosal Melanoma

Authors

  • Shine Sadasivan

    1   Department of Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

  • Keechilat Pavithran 

    2   Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

  • Roopa Rachel Paulose

    3   Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

  • Sudheer Othiyil Vayoth

    4   Department of Surgical Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Funding None.
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A 69-year-old female was treated for nasal mucosal melanoma in 2023 with surgery (stage pT3N0M0) and was followed up. In July 2024, the patient was evaluated for anemia and fatigue for 1 month. The stool occult blood test results were positive. Esophagogastroduodenoscopy revealed a 7 × 6 cm ulceroproliferative lesion with necrosis and melanosis in the proximal gastric body and greater curvature of the stomach ([Fig. 1A, B]). Altered blood was observed throughout the stomach and duodenum. Histopathology (HPE) showed gastric mucosa with a tumor in the submucosa ([Fig. 2A]). Tumor cells were small to medium-sized with scant to moderate eosinophilic cytoplasm arranged in sheets ([Fig. 2B]). Immunohistochemistry showed strong S100 positivity, patchy HMB45 positivity ([Fig. 2C]), and strong expression of Melan A in tumor cells ([Fig. 2D]), confirming the diagnosis of malignant melanoma. Positron emission tomography/computed tomography scan showed metabolically active irregular wall thickening involving the fundus and greater curvature of the stomach and metabolically active peri-gastric lymph nodes. The patient underwent a radical gastrectomy and splenectomy. HPE confirmed metastatic malignant melanoma of the stomach with regional lymph node metastasis. She was advised immunotherapy, but was lost to follow-up.

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Fig. 1 (A, B) A 7 × 6 cm ulceroproliferative lesion seen in the proximal gastric body along the greater curvature with altered blood.
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Fig. 2 (A) Histopathology images: H&E 100× gastric mucosa with tumor in submucosa. (B) H&E 200 × : tumor cells arranged in sheets. (C) Immunohistochemistry: HMB-45 expressed in tumor cells. (D) Immunohistochemistry: Melan A—strongly expressed in tumor cells.

Practical Implications for Endoscopists

  • Mucosal melanomas are a rare subtype of melanoma, accounting for 1% of all melanomas. Apart from ocular melanoma, it includes head and neck melanomas (50%) and gastrointestinal (GI), anorectal, genitourinary, and respiratory melanomas.[1] [2]

  • GI melanoma is usually asymptomatic, which makes early detection difficult.

  • The GI tract is a frequent site for metastatic spread from other melanoma primaries. The most common site of melanoma metastasis is the greater curvature of the gastric body (∼80%), followed by the fundus and antrum.

  • The small bowel has an affinity for malignant melanoma because of the expression of CCL25 by the small bowel, which has an affinity for the CCR9 chemokine receptor on the cell surface of melanoma cells.[3]

  • There are three types of endoscopic lesions in gastric metastasis of melanoma: multiple ulcerated melanotic nodules, subepithelial mass lesions with ulceration, and mass lesions with necrosis and melanosis.

  • As it is difficult to differentiate between primary gastric melanoma and metastatic melanoma based on endoscopic appearance, a careful search for subepithelial lesions with ulcerations and melanosis must be performed during the endoscopy. If subepithelial lesions are observed without ulceration, endoscopic ultrasound-guided fine-needle biopsy may be required.

  • The overall survival rate at 2 years is 4%. The survival of patients with multiple gastric metastases is very low compared with that of patients with a solitary metastasis.[3]



Conflict of Interest

None declared.

Authors' Contributions

All authors contributed to the writing of the manuscript.


Patient's Consent

Patient's written consent was obtained for the publication of the case details.



Address for correspondence

Keechilat Pavithran, MD, DM, FRCP
Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham
Kochi 682041, Kerala
India   

Publication History

Article published online:
10 December 2025

© 2025. 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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Zoom
Fig. 1 (A, B) A 7 × 6 cm ulceroproliferative lesion seen in the proximal gastric body along the greater curvature with altered blood.
Zoom
Fig. 2 (A) Histopathology images: H&E 100× gastric mucosa with tumor in submucosa. (B) H&E 200 × : tumor cells arranged in sheets. (C) Immunohistochemistry: HMB-45 expressed in tumor cells. (D) Immunohistochemistry: Melan A—strongly expressed in tumor cells.