Jejunal metastatic melanoma presenting with occult gastrointestinal haemorrhage and refractory anaemia

Malignant melanoma is the most common tumour to metastasise to the gastrointestinal (GI) tract; however, symptomatic involvement is uncommon during life. We report a case of small bowel metastatic melanoma presenting as a large aneurysmal jejunal mass in an elderly man with chronic iron-deficiency anaemia and weight loss many years after excision of early-stage cutaneous melanomas. Despite cross-sectional imaging and endoscopic investigations, diagnosis remained uncertain until exploratory laparotomy was performed. En bloc resection of the jejunal segment with associated mesentery achieved complete excision and histopathology confirmed metastatic melanoma. Although molecular analysis identified a BRAF mutation, severe cardiac comorbidity precluded systemic therapy. This case highlights the diagnostic challenges of GI melanoma metastasis, the uncharacteristic radiological appearance of aneurysmal dilatation and the continued role of surgical resection for symptom control and definitive diagnosis in selected patients.