Small Bowel Metastasis in a Stage IV Melanoma Patient: A Report of Multimodal Approach

Among all skin cancers melanoma is the most aggressive and the first responsible of death because of its metastatic power. Small bowel melanoma metastases are a rare condition, probably underestimated if we consider the high incidence in autoptic findings. Usually, it comes as a single or multiple protruding lesions with polypoid aspects that is able to cause intussusception, blood loss anemia, and palpable mass and abdominal pain. We present a case of a 58-year-old male, diagnosed in July 2018 for melanoma that in 2021 showed sudden anemia. Video Capsule Endoscopy demonstrated an ulcerated lesion in the proximal ileum. Several approaches are available for the treatment of this lesion, but specific indications for surgery have not yet been defined. We adopted a watchful waiting approach to not let the patient undergo an excessive surgical stress, considering the risk of tumor progression. Surgery was performed after multidisciplinary revision of the case.