At first glance, this appears to be a case of a bleeding GIST. However, there are multiple gastric nodules, all with a dark centre. This is a case of metastatic melanoma and you should have asked about funny lesions on the skin.
Malignant melanoma has a peculiar predilection for the gastrointestinal tract. It’s one of the more common findings in the small bowel of younger patients with anaemia. In an old post mortem series, the prevalence of GI metastasis in patients with melanoma was only 0.9% in 1000 melanoma patients (Arch Surg 1964:88:969-973). However, when you look at cases with advanced disease, up to 50% will have GI metastases (Cancer 1964;17:1323-39). As one may expect, the most common presentation is with anaemia or obstructive symptoms.
Interestingly, surgical resection has been linked with longer survival! In a small series, the 5 year survival was a remarkable 38% (Arch Surg 1996;131 :975-980).In contrast, without surgical intervention, the prognosis is grim and Amer et al. (Gynecol Obstet 1979;149:687-92) reported a mean survival time of only 9.7 months, whilst others have reported an even shorter median survival of 4.7 months. Nevertheless, I am suspicious that it is case selection which is the reason for the apparent survival benefit of surgery.
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