Anna Favia, Grazia D’Alesio, Maria Rosaria Fracella
Melanoma of unknown primary site represents 1-8% of all melanomas and can be diagnosed by exclusion after examining all possible origin areas of the primary tumor. We report the case of a young lady referred to receive Magnetic Resonance Imaging (MRI) to investigate suspicious hepatic lesions seen by ultrasound. Three years earlier, the patient underwent left inguinal lymphadenectomy for metastatic melanoma with unknown primary site. No clinical evidence of a primary tumor was found at physical examination (dermatological/ophthalmological) or at gastro-duodenoscopy/ileo-colonoscopy. CT scans performed annually were negative for melanoma lymph node recurrence and distant metastases. At MRI sequences, we excluded the presence of liver metastasis but we identified small bowel metastases from melanoma as incidental findings. The patient has been subjected to exeresis of small bowel lesions and anatomopathological examination confirmed the diagnosis made by imaging. At present, the primary tumor has yet to be identified.