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Quick Picture Challenge
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A 50-year-old woman presented with a two-week history of colicky abdominal pain and underwent a laparotomy. What is the diagnosis?
- Foreign body reaction
- Ischaemic ulceration
- Metastatic melanoma
- Carcinoma of the caecum
Feedback:The opened specimen of small bowel shows an exfoliative lesion. It is black - this is a deposit of melanoma. On further questioning the patient stated she had a melanoma excised from her back 15 years earlier. The lag time for metastatic disease to present after excision of a primary cutaneous melanoma can be many years and can occur virtually anywhere in the body. The gastrointestinal tract is a relatively common site for metastatic disease. Melanoma must be considered in the diagnosis of any patient who presents with malignant small bowel obstruction.