Duodenal obstruction and bleeding: pancreatico duodenectomy for a malignant melanoma of the duodenum

We report a case of melanoma of duodenum occurred many years after the surgical excision of the primitive skin lesion. Clinical presentation, and surgical treatment are described. The neoplasia, cause of abdominal pain, upper gastrointestinal bleeding and obstruction, was diagnosed by esophago-gastro-duodenoscopy and staged by endoscopic ultrasonography (EUS) and computerized tomography (CT) scan. An aggressive surgical management was carried out by pancreaticoduodenectomy. Radical excision represents the treatment of choice to improve the survival and the quality of life. A curative intent is viable but rarely feasible since metastatic melanoma is an aggressive tumour and occult metastatic disease exists elsewhere. Surgery should theoretically be followed by some form of adjuvant therapy, but several studies and clinical trials are still in progress.