Metastatic Melanoma in an 83-year-old Man

An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.

Drs Abdul M. Swied and Madhuri Trivedi of the University of Missouri–Columbia, report that mild abdominal distention and bilateral lower extremity pitting edema were noted. A 3 × 5-cm lesion was also found on the patient's back (A). Sodium level was 128 mEq/L; blood urea nitrogen, 100 mg/dL; creatinine, 2.8 mg/dL; mean corpuscular volume, 79 µm3; and hemoglobin, 8.5 g/dL (6 months earlier, hemoglobin measured 14.4 g/dL). A CT scan of the head, taken when the patient was admitted to the hospital, was normal.

Because of the anemia, a colonoscopy and an esophagogastroduodenoscopy (EGD) were performed. The EGD revealed a “bull's-eye” ulcer in the second part of the duodenum (B); a biopsy of the lesion confirmed the diagnosis of metastatic melanoma (C). An abdominal CT scan also showed metastasis to the liver and spleen (D, arrows).

Metastases to the GI tract may be difficult to diagnose. These tumors may appear as a nodule, mass, or ulcer and can lead to obstruction and bleeding. The bull's-eye appearance is typical of melanoma metastases to the stomach or small intestine.

Metastatic melanoma is incurable; treatment with chemotherapeutic or biologic agents is usually palliative. Typically, patients survive for less than 1 year.

This patient refused treatment. He relocated to another state and was lost to follow-up.