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The histological features of the gastric mucosa, infiltrated by epitheloid and spindle cells, were suggestive of a metastatic malignant melanoma. This was confirmed with HMB45, MART-1, and tyrosinase (pan-melanoma cocktail) positivity. His computed tomography scan had shown evidence of widespread metastatic disease with hepatic, mesenteric, and retroperitoneal lesions. He was managed conservatively and died two months after discharge.
The incidence of melanoma is rising and now represents 3% of all newly diagnosed cancers and is the leading fatal illness arising in the skin. While excision of early disease is potentially curative, it is an aggressive cancer which frequently metastasises. The gastrointestinal tract is a common site of metastasis. Fifty per cent of patients with metastatic melanoma will have a gastrointestinal tract metastasis, although only 9% of these are detected during life. The most common sites for metastases are the small bowel (60%), colon (20%), and stomach (20%). Symptoms from malignant deposits in the gastrointestinal tract are rare and frequently present late in the course of the disease. Common modes of presentation are anaemia and intestinal haemorrhage, although intussusception and acute bowel obstruction can also occur. While treatment options exist for primary disease, the prognosis of metastatic melanoma remains poor, with an average prognosis for those with stage IV disease of less than six months. Recent research has suggested a possible improved prognosis and quality of life among patients with early diagnosis and surgical resection of gastrointestinal melanoma metastases.
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