Sliced Tomato Appearance of Malignant Melanoma: Diffuse Involvement of the Upper Gastrointestinal Tract Presenting With Melena

CASE REPORT In medical literature, examples exist where medical descriptions have been linked to culinary nomenclature. Examples include rice water diarrhea, currant jelly stool of intussusception, bread and butter pericarditis, or the anchovy contents of amoebic abscess. These images (Figure 1) are from a 71-year-old man originally presenting with melena, displaying a rare finding metastatic malignant melanoma presenting with an unusual appearance in a rare location, the duodenum, resembling multiple small, sliced tomatoes. Biopsies obtained proved the multiple nodular, ulcerated masses to be metastatic malignant melanoma. He subsequently underwent aggressive chemotherapy, with complete resolution of disease.Figure 1.: Serial images of malignant melanoma in the duodenum presenting with the appearance of sliced tomatoes, an unusual finding.Although melanoma does metastasize to various parts of the body, it infrequently affects the gastrointestinal tract, and when it does, it usually presents within the ileum or jejunum as isolated lesions.1–3 The present case illustrates a unique and unusual appearance in the duodenum that resembles sliced tomatoes. Furthermore, complete resolution with chemotherapy is rare, specifically with metastatic disease and those presenting with multiple gastrointestinal lesions, factors that carry a poor prognosis.4 DISCLOSURES Author contributions: N. Bartosek and I. Gill: design of the work; acquisition, analysis, and interpretation of data for the work. N. Bartosek: drafting and reviewing intellectual content including formations of text and images; submission of final text and imagery. A. Patel: design of the work; acquisition of endoscopic images and initial endoscopy; analysis, and interpretation of data for the work. I. Gill and A. Patel: improving text and images; draft revision, and review of final text and imagery. All authors agree to be accountable for all aspects of the work. N. Bartosek is the article guarantor. Financial disclosure: None to report. Care provided to patient numerous years prior to image publishing. We were unable to contact the patient for consent.