Recurrent Jejunal Melanoma Presenting as Obscure Gastrointestinal Bleeding: A Diagnostic Challenge

Melanoma commonly metastasizes to the gastrointestinal tract but is often asymptomatic. Symptomatic small intestinal metastatic melanoma presenting with overt gastrointestinal bleeding is uncommon and may be difficult to diagnose when the initial radiographic and endoscopic workup is unrevealing. We report a 47-year-old patient with prior stage III cutaneous melanoma status post wide local excision and sentinel lymph node biopsy, who declined adjuvant immunotherapy and surveillance, presenting with acute blood loss anemia occurring 3 years after definitive treatment. After nondiagnostic radiographic evaluation, esophagogastroduodenoscopy, colonoscopy, and push enteroscopy, anterograde double-balloon enteroscopy revealed an actively bleeding ulcerated midjejunal mass, later measuring 6 cm on surgical pathology, with pathology confirming the diagnosis of metastatic melanoma.