{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T14:58:22Z","timestamp":1763564302952,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>A 72-year-old man visited cardiology for exertional chest pain, lightheadedness, and fatigue. Six years prior, he was surgically treated for cutaneous malignant melanoma of the lower back. After a negative cardiac work-up, primary care diagnosed severe iron deficiency anemia. Emergent upper and lower gastrointestinal (GI) endoscopy revealed simultaneous melanoma metastases to the stomach and colon with discrete macroscopic features. Metastatic disease, including brain, lung, and bone, was discovered on imaging. Treatment included immunotherapy with nivolumab and stereotactic radiosurgery of the brain metastases, and our patient has remained in continued remission even after 2 years. Melanoma with GI tract (GIT) metastasis has a poor prognosis and rarely presents symptomatically or with synchronous gastric and colonic lesions. This case illustrates the importance of early primary care involvement to expedite work-up for multifocal GI metastases in patients with a remote melanoma history presenting with symptoms related to iron deficiency anemia (IDA).<\/jats:p>","DOI":"10.3389\/fmed.2023.1268973","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T11:47:11Z","timestamp":1698925631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Gastric and colonic metastases of malignant melanoma diagnosed during endoscopic evaluation of symptomatic anemia presenting as angina: a case report"],"prefix":"10.3389","volume":"10","author":[{"given":"Manuel A.","family":"Amaris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrique E.","family":"Kallas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H.","family":"Gonzalo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank A.","family":"Orlando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.gie.2018.02.019","article-title":"Secondary tumors of the GI tract: origin, histology, and endoscopic findings","volume":"88","author":"Gilg","year":"2018","journal-title":"Gastrointest Endosc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/0002-9610(78)90171-X","article-title":"Metastatic pattern of malignant melanoma","volume":"135","author":"Patel","year":"1978","journal-title":"Am J Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e608","DOI":"10.7759\/cureus.608","article-title":"Melanoma metastasizing to the small intestine: A case report illustrating symptomatic and asymptomatic involvement","volume":"8","author":"Asad-Ur-Rahman","year":"2016","journal-title":"Cureus."},{"key":"B4","doi-asserted-by":"publisher","first-page":"511","DOI":"10.4065\/81.4.511","article-title":"Metastatic malignant melanoma of the gastrointestinal tract","volume":"81","author":"Liang","year":"2006","journal-title":"Mayo Clin Proc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"107907","DOI":"10.1016\/j.ijscr.2023.107907","article-title":"Two unique cases of metastatic malignant melanoma of the gastrointestinal tract","volume":"103","author":"Ahmed","year":"2023","journal-title":"Int J Surg Case Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.ijscr.2012.03.033","article-title":"Intestinal melanoma: A broad spectrum of clinical presentation","volume":"3","author":"Patti","year":"2012","journal-title":"Int J Surg Case Rep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1477-7819-9-14","article-title":"Pathogenesis, diagnosis and management of primary melanoma of the colon","volume":"9","author":"Khalid","year":"2011","journal-title":"World J Surg Oncol."},{"key":"B8","first-page":"188","article-title":"18F-FDG PET\/CT imaging of primary malignant melanoma of rectum with liver metastases mimicking rectum cancer: case report and literature review","volume":"12","author":"Qiu","year":"2022","journal-title":"Am J Nucl Med Mol Imaging."},{"key":"B9","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1186\/s12957-022-02721-z","article-title":"Primary colonic melanoma: a rare entity","volume":"20","author":"Xie","year":"2022","journal-title":"World J Surg Oncol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1007\/s00595-004-2741-5","article-title":"Gastrointestinal metastases from malignant melanoma: report of a case","volume":"34","author":"Wysocki","year":"2004","journal-title":"Surg Today."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1053\/j.gastro.2020.06.046","article-title":"AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia","volume":"159","author":"Ko","year":"2020","journal-title":"Gastroenterology."},{"key":"B12","doi-asserted-by":"publisher","first-page":"458","DOI":"10.14309\/ajg.0000000000001122","article-title":"Clinical guidelines: colorectal cancer screening 2021","volume":"116","author":"Shaukat","year":"2021","journal-title":"Am J Gastroenterol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1080\/14737140.2018.1489246","article-title":"The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: Implications for melanoma treatment and care","volume":"18","author":"Keung","year":"2018","journal-title":"Expert Rev Anticancer Ther."},{"key":"B14","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1038\/modpathol.2016.24","article-title":"Metastatic malignancy to the upper gastrointestinal tract encountered on endoscopic biopsy: a clinicopathologic study","volume":"30","author":"Patel","year":"2017","journal-title":"Mod Pathol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"155","DOI":"10.21294\/1814-4861-2020-19-6-155-160","article-title":"Metastatic multiple primary gastrointestinal melanoma: A case report","volume":"19","author":"Kostromitsky","year":"2020","journal-title":"Sib J Oncol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"S884","DOI":"10.14309\/01.ajg.0000781684.80342.ba","article-title":"A case report of a synchronous gastrointestinal melanoma: A multidisciplinary approach","volume":"116","author":"Sazon","year":"2021","journal-title":"Am J Gastroenterol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jid.2018.07.009","article-title":"Outcomes and risk factors in patients with multiple primary melanomas","volume":"139","author":"Nosrati","year":"2019","journal-title":"J Invest Dermatol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"3713","DOI":"10.21873\/anticanres.12650","article-title":"Abdominal emergencies in patients with stage IV melanoma: The role of surgery: A single-centre experience","volume":"38","author":"Mantas","year":"2018","journal-title":"Anticancer Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/S0016-5107(78)73493-0","article-title":"Malignant melanoma metastatic to the upper gastrointestinal tract: endoscopic and radiologic correlations, form and evolution of lesions, and value of directed biopsy in diagnosis","volume":"24","author":"Nelson","year":"1978","journal-title":"Gastrointest Endosc."},{"key":"B20","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3389\/fmolb.2020.00154","article-title":"Current state of target treatment in BRAF mutated melanoma","volume":"14","author":"Tanda","year":"2020","journal-title":"Front Mol Biosci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1884","DOI":"10.1093\/annonc\/mdz411","article-title":"Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"30","author":"Michielin","year":"2019","journal-title":"Ann Oncol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"742","DOI":"10.3390\/cancers12030742","article-title":"The role of PTEN loss in immune escape, melanoma prognosis and therapy response","volume":"12","author":"Cabrita","year":"2020","journal-title":"Cancers."},{"key":"B23","doi-asserted-by":"publisher","first-page":"946","DOI":"10.3390\/cancers12040946","article-title":"TERT promoter mutations differently correlate with the clinical outcome of MAPK inhibitor-treated melanoma patients","volume":"12","author":"Bianco","year":"2020","journal-title":"Cancers."},{"key":"B24","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1200\/JCO.2014.57.4756","article-title":"Vitiligo-like depigmentation in patients with stage III-IV melanoma receiving immunotherapy and its association with survival: a systematic review and meta-analysis","volume":"33","author":"Teulings","year":"2015","journal-title":"J Clin Oncol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1268973\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T11:47:31Z","timestamp":1698925651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1268973\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,2]]},"references-count":24,"alternative-id":["10.3389\/fmed.2023.1268973"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1268973","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2023,11,2]]},"article-number":"1268973"}}