title: Metastatic malignant melanoma of the small bowel--report of two cases.
abstract: METHODS
  We report two cases of malignant melanoma metastasizing to the ileum and jejunum in a 48-year-old female and 62-year-old male, respectively. The female patient was a known case of vaginal melanoma who on follow-up developed pain abdomen 4 years after excision of the primary, whereas the male patient who was initially referred as pleomorphic spindle cell sarcoma of the groin presented with complaints of bleeding per rectum and melena 6 years later.
  
  
  RESULTS
  After preliminary investigations both underwent laparotomy and resection of segments of ileum and jejunum with tumor. Histopathological examination with immunohistochemistry showed features suggestive of metastatic malignant melanoma.
  
  
  CONCLUSIONS
  Metastasis should be suspected in patients with malignant melanoma who develop gastrointestinal symptoms such as abdominal pain, anemia, melena, fatigue, constipation, small bowel obstruction, or perforation. This helps in avoiding a delay in the diagnosis and complications that arise due to metastatic disease.
  
  
  CONCLUSIONS
  Our first patient with primary vaginal melanoma died of multiple metastases 11 months following surgery for the ileal metastasis while the second patient with jejunal metastasis developed recurrent disease in the small bowel and iliac lymph nodes 10 months after surgery. However, in a patient with isolated gastrointestinal metastasis, diagnosed early, with good general condition surgical management should be encouraged when a complete resection of the disease is feasible as no other treatment option is as good for relief of symptoms and prolongation of life.
authors.affiliation: Pathology, Cancer Institute (WIA), Chennai, India. shirleysundersingh@hotmail.com
authors.forename: Shirley
authors.initials: S
authors.lastname: Sundersingh
authors.forename: Urmila
authors.initials: U
authors.lastname: Majhi
authors.forename: Senthil Kumar A
authors.initials: SK
authors.lastname: Chandrasekar
authors.forename: Ramakrishnan A
authors.initials: RA
authors.lastname: Seshadri
authors.forename: Suresh Kumar
authors.initials: SK
authors.lastname: Dakshinamurthy
authors.forename: Kathiresan
authors.initials: K
authors.lastname: Narayanaswamy
mesh_terms: D005260:Female; D006119:Groin / Q000473:pathology; D006801:Humans; D007078:Ileal Neoplasms / Q000556:secondary*; D007150:Immunohistochemistry; D007580:Jejunal Neoplasms / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000556:secondary*; D008875:Middle Aged; D012509:Sarcoma / Q000473:pathology; D014625:Vaginal Neoplasms / Q000473:pathology*