Image of the Month| Volume 46, ISSUE 12, P1133, December 2014

Dark macules in the upper gastrointestinal tract: An ominous sign

Published:August 14, 2014DOI:
      A previously healthy 42-year-old man presented with a 3-month history of non-specific abdominal pain associated with anorexia, nausea and vomiting. Apart from slightly elevated liver enzymes, his laboratory investigations were unremarkable. An abdominal ultrasound showed multiple liver lesions consistent with metastases; a computed tomography scan of his chest, abdomen and pelvis confirmed these findings, however no primary lesion was identified. At upper gastrointestinal endoscopy, multiple dark brown macules (2–5 mm in diameter) were seen within the stomach (Fig. 1A ) and duodenum (Fig. 1B). Histological examination of biopsies of these lesions with immunostaining with Melan-A showed features of metastatic malignant melanoma (Fig. 1C). On thorough examination of the skin, no primary lesion was identified.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Köklü S.
        • Gültuna S.
        • Yüksel I.
        • et al.
        Diffuse gastroduodenal metastasis of conjunctival malignant melanoma.
        American Journal of Gastroenterology. 2008; 103: 1321-1323