The Videocapsule Endoscopy Role in the Early Diagnosis of Small Bowel Melanoma Metastasis: A Particular “Coal Black” Endoscopic Appearance

Background: Small bowel melanoma metastasis can be very tricky to diagnose. Videocapsule endoscopy allows the exploration of the entire small bowel and might represent a very useful tool in the melanoma staging. Methods: we describe the clinical history of two male patients of 31 and 75 years old affected by melanoma. Both were admitted to the hospital for melena. Esophagogastroduodenoscopy and colonoscopy failed to show causes of bleeding. We performed videocapsule endoscopy to find the bleeding source. Results: The youngest patient had countless black or blue lesions and a big bleeding ulcer with a "coal black" depression with exophytic whitish borders (the so-called "solar eclipse"). He underwent successful jejunum resection but died for brain metastasis two months later. The second patient showed five sessile and pedunculated polypoid lesions and a peculiar extensive black ulceration surrounded by whitish area, very similar to that of the youngest patient. Small bowel resection was performed and the patient is still alive. Conclusions: Haemorrhagic small bowel melanoma metastasis seem to have a peculiar endoscopic appearance. Introducing videocapsule in the melanoma staging could lead to early diagnosis and early treatment helping to improve survival rates. Further investigations are needed to increase our knowledge in this field.