Duodenal metastasis of malignant melanoma observed by magnification endoscopy.

most common source of metastasis to the gastrointestinal tract, the features of these metastases as viewed by magnifica− tion endoscopy have not been reported. A 77−year−old man whose right great toe had been amputated 3 years previously due to malignant melanoma underwent endoscopy because he was anemic. Mul− tiple black, depressed lesions (1± 5 mm in diameter) with a “bull’s eye“ appearance were viewed in the descending duode− num (l" Fig. 1). Under magnification, the surface of these lesions was smooth (l" Fig. 2 and 3), and histological exami− nation of a biopsy specimen (l" Fig. 4) re− vealed tumor cells full of brown pigment (l" Fig. 5). Additional sites of metastasis were found in the ascending colon (by co− lonoscopy) and in the pulmonary hilar lymph node (by CT). Because of appetite loss, the patient underwent gastrointesti− nal endoscopy again 2 months later. In− creased numbers of black, depressed le− sions were seen, larger than before, and tiny black spots viewed under magnifica− tion showed a similar smooth surface (l" Fig. 6). A diagnosis of malignant melanoma ± a frequent source of metastatic disease in the gastrointestinal tract [1, 2] ± requires identification of melanoma features that distinguish it from other tumors. The use of magnification endoscopy for this pur− pose in the upper gastrointestinal tract is increasingly common. In the duodenum, Badreldin et al. suggested that zoom en− doscopy is valuable in assessing the de− gree of villous atrophy in celiac disease [3]. Magnified endoscopic views of early duodenal carcinoma [4], as well as duo− denal metastasis of malignant melanoma (here), were found to correspond accu− rately with histopathological findings. We conclude that magnification endosco− Duodenal metastasis of malignant melanoma observed by magnification endoscopy