title: Primary small bowel melanomas: fact or myth?
abstract: Small bowel melanoma (SBM) is a rare entity, which often evades diagnosis and therefore presents late. Its origin, whether arising primarily or metastatically from an unidentified or regressed primary cutaneous melanoma, remains debatable. In this report, we present a rare case of primary SBM and review the current literature. A 60-year-old man presented with melena and microcytic anemia. A series of investigations including abdominal ultrasonography (US), esophago-gastro-duodenoscopy (EGD) and colonoscopy were normal. Abdominal computed tomography revealed no specific pathology. Subsequent capsule endoscopy identified a jejunal mass, which was confirmed on laparotomy, was resected, and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. This report discusses gastrointestinal (GI) malignant melanoma, and examines the evidence both for and against the existence of true primary vs. metastatic disease. Furthermore, this case highlights the capabilities of capsule endoscopy in identifying an extremely rare GI tumor, which evaded other diagnostic modalities. Finally, the origins and pathophysiology of this rare cancer are evaluated, with the aim of promoting early diagnosis and treatment, and therefore improving current poor outcomes.
authors.affiliation: 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Andreas V
authors.initials: AV
authors.lastname: Hadjinicolaou
authors.affiliation: 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hadjittofi
authors.affiliation: 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Athanasopoulos
authors.affiliation: 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shah
authors.affiliation: 1 Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK ; 2 Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, UK ; 3 Department of HPB & Liver Transplant Surgery, Royal Free Hospital, London, UK ; 4 Department of Gastroenterology, Frimley Park NHS Foundation Trust, Portsmouth Road, Frimley, Surrey, UK ; 5 Department of Gastroenterology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Aftab A
authors.initials: AA
authors.lastname: Ala
keywords: Bowel; capsule; endoscopy; intestine; melanoma