Primary giant aggressive amelanotic duodenal melanoma

&NA; Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35‐year‐old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endoscopy demonstrated a large, friable mass along the duodenal wall and biopsy was suggestive of malignant melanoma. A detailed physical examination and whole body imaging (positron emission tomography and computed tomography) did not reveal any other lesion. The patient underwent a pancreaticoduodenectomy with segmental resection and anastomosis of the superior mesenteric vein as well as a segmental colectomy. His postoperative recovery was uneventful. The histopathology of the operative specimen showed a malignant amelanotic melanoma arising from the duodenum with lymph nodal involvement. He received oral temozolomide. However, he developed liver metastasis at six months and again at ten months, which was managed with radiofrequency ablation both times. He is doing well at 32 months of follow‐up review. Multimodality treatment including surgery, adjuvant chemotherapy and salvage therapy appears to be a promising tool for achieving long‐term survival in such patients.

[1]  Ö. Başar,et al.  A Rare Cause of Upper Gastrointestinal Bleeding in an Elderly Patient: Primary Duodenal Malignant Melanoma , 2014, Journal of Gastrointestinal Cancer.

[2]  M. Igarashi,et al.  Primary amelanotic malignant melanoma of the small intestine diagnosed by esophagogastroduodenoscopy before surgical resection , 2013, Clinical Journal of Gastroenterology.

[3]  R. Stipić,et al.  Melanoma in the ampulla of Vater. , 2013, Hepatobiliary & pancreatic diseases international : HBPD INT.

[4]  Hai Xu,et al.  Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma , 2012, Diagnostic Pathology.

[5]  M. Lens,et al.  Melanoma of the small intestine. , 2009, The Lancet. Oncology.

[6]  G. Plataniotis,et al.  Primary malignant melanoma of the duodenum: aggressive management and long-term survival of an unusual oncologic entity. , 2008, Southern medical journal.

[7]  A. Feller,et al.  Primary Malignant Melanoma of the Small Bowel a Case Report and Review of the Literature , 2005, Tumori.

[8]  N. O’higgins,et al.  Positron emission tomography for staging and management of malignant melanoma , 2002, The British journal of surgery.

[9]  D. Rex,et al.  Malignant melanoma: Patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance , 2001, American Journal of Gastroenterology.

[10]  L. Lowe,et al.  Do primary small intestinal melanomas exist? Report of a case. , 1999, Journal of the American Academy of Dermatology.

[11]  L. Sobin,et al.  Malignant melanomas in the small intestine: a study of 103 patients. , 1996, The American journal of gastroenterology.

[12]  T. P. Wade,et al.  Small bowel melanoma: extended survival with surgical management. , 1995, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[13]  E. Tejada,et al.  Malignant melanoma in Meckel's diverticulum. , 1986, American journal of clinical pathology.

[14]  M. Krausz,et al.  Primary malignant melanoma of the small intestine and the APUD cell concept , 1978, Journal of surgical oncology.

[15]  V. McGovern SPONTANEOUS REGRESSION OF MELANOMA , 1975, Pathology.