Gastrointestinal bleeding as presentation of small bowel metastases of malignant melanoma: Is surgery a good choice?

• We examine two case reports about bowel metastasis of malignant melanoma.
• We consider the several methods to make a diagnosis and we would promote gastrointestinal investigations in patients with melanoma.
• We underline the importance of regular follow-up and we would stress the role of surgeon in encouraging patients and supporting the easier way to do that in order to avoid “lost to follow-up”.
• We propose surgery as a good option to control melanoma disease even if in cases of spread involvement in order to remove the source of acute symptoms and improve quality of life.

INTRODUCTIONMelanoma shows a particular predilection in involving small intestine both in a single site and in multiple localization and acute or chronic gastrointestinal bleedings are often the first sign of tumour.PRESENTATION OF CASEWe report two cases of GI metastases of malignant melanoma, one presented with only a big mass that cause intestinal obstruction and the other with a tumour spread throughout the small intestine that produce enterorrhagia.DISCUSSIONDiagnosis and follow-up are very difficult: CT scan, PET-CT scan and capsule endoscopy should be complementary for the assessment of patients with GI symptoms and melanoma history.CONCLUSIONWhat is the role of surgery? Several studies suggest metastasectomy to achieve both R0 results and palliative resolutions of acute symptoms, such as obstruction, pain, and bleeding.