The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Melanoma Metastatic to the Duodenum

A B

Themistoklis Kourkoumpetis, M.D.
Maria E. Jarbrink-Sehgal, M.D.
Baylor College of Medicine
Houston, TX
kourkoum@bcm.edu
A
n 87-year-old man presented to the emergency department
with a 3-week history of progressive nausea, intermittent coffee-ground
emesis, anorexia, and weight loss. The patient had a history of type 2
diabetes mellitus, peripheral artery disease, and aortic-valve replacement. Labo-
ratory evaluation showed microcytic anemia and severe iron deficiency. Upper
endoscopy revealed a pigmented mass in the duodenal bulb (Panel A) and two
additional masses in the second and third portions of the duodenum (Panel B).
Biopsies of these lesions confirmed a diagnosis of melanoma. The patient had
received no prior diagnosis of cutaneous melanoma. Positron-emission tomog-
raphy–computed tomography revealed fluorodeoxyglucose uptake in the duode-
num, omentum, and subcarinal, retroperitoneal, and superficial inguinal lymph
nodes, findings that are consistent with widely metastatic disease. Melanoma
can metastasize to many organ systems, including the gastrointestinal tract.
After the diagnosis was made, the patient’s care was transferred to an oncology
center for further treatment.
DOI: 10.1056/NEJMicm1702470
Copyright © 2017 Massachusetts Medical Society.

e34 n engl j med 377;25 nejm.org December 21, 2017

The New England Journal of Medicine

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