Subcapsular Hepatic Hemorrhage: An Uncommon and Catastrophic Manifestation of Metastatic Melanoma

Subcapsular hepatic hematoma is a rare but potentially life-threatening manifestation of metastatic melanoma, often presenting with vague abdominal pain and risk of misdiagnosis. We report a 76-year-old man with a history of malignant melanoma who presented with acute epigastric pain radiating to the right shoulder, vomiting, and a syncopal episode. While initial blood tests showed mild leukocytosis and raised lactate, a CT aorta excluded dissection but revealed multiple hepatic metastases with a large subcapsular hematoma and pulmonary nodules. A follow-up CT mesenteric angiogram demonstrated interval hematoma expansion without active bleeding, further metastatic progression, and a segmental pulmonary embolus. Owing to frailty and advanced malignancy, a multidisciplinary team recommended conservative management. This case highlights the diagnostic conundrum of hepatic hemorrhage in melanoma, which may mimic other acute pathologies such as aortic dissection or acute coronary syndrome. Prompt cross-sectional imaging, serial monitoring, and early multidisciplinary input are essential for accurate diagnosis and for balancing intervention risk against quality of life in complex oncology presentations.