S6471 Incidental Detection of Metastatic Melanoma in the Stomach During Evaluation for Persistent Dysphagia

Introduction: Metastatic melanoma (MM) to the gastrointestinal (GI) tract is uncommon but can present with nonspecific symptoms, such as abdominal pain, weight loss, nausea, vomiting, GI bleeding, or iron deficiency anemia. Dysphagia is a common symptom with a broad differential ranging from structural to motility disorders. Rarely, it can lead to the incidental diagnosis of metastatic malignancy. This case highlights an elderly man with dysphagia, ultimately found to have metastatic melanoma of the stomach. Case Description/Methods: An 88-year-old man presented with dysphagia. Esophagogastroduodenoscopy (EGD) revealed Los Angeles (LA) grade B esophagitis, 3 superficial esophageal ulcers and gastritis. Esophageal biopsies showed reflux esophagitis. He was started on pantoprazole 40 mg daily with symptomatic improvement. A modified barium swallow study (MBSS) showed mild pharyngeal deficits and possible esophageal dysphagia. After 1 month, he remained well controlled. However, after 6 months, he reported recurrence of dysphagia to solids and liquids. Repeat EGD was performed showing diffuse, moderate antral inflammation, a 7 mm sessile polyp with a dark rim in the gastric body. Gastric biopsies showed mild chronic gastritis. The gastric polyp biopsy revealed metastatic melanoma. He was referred to oncology for staging and further evaluation, including assessment for a primary cutaneous lesion. Further management - including consideration of endoscopic ultrasound and polyp resection - would have depended on the extent of disease and systemic treatment planning. However, the patient elected to pursue hospice care and ultimately passed away comfortably in his own home. Discussion: Melanoma metastases to the GI tract can present with vague symptoms or as incidental findings on routine evaluation. Although up to 60 percent of melanoma patients show GI involvement at autopsy, only 1 to 5 percent are symptomatic during their lifetime. Lesions may appear as ulcers, masses, or polyps, and may go unnoticed without thorough evaluation. This case highlights the importance of timely endoscopy in patients with recurrent or refractory dysphagia, even when initial workup is benign. Treatment includes systemic immunotherapy or targeted therapy, with local endoscopic resection reserved for symptom relief or localized disease. This case also illustrates how common GI complaints may occasionally lead to the discovery of advanced malignancy with poor prognosis, reinforcing the importance of individualized goals-of-care discussions.