Case Report: The Elephant in the Room: Skin Melanoma Unveiled by Gastric Metastasis [version 2; peer review: 1 approved, 1 approved with reservations]

Abstract Background Gastric metastasis from melanoma is rare and often presents as an unexpected finding, rarely revealing an underlying primary skin melanoma. Case presentation We report a case of a 62-year-old male who presented with abdominal pain, dyspepsia, anorexia, and weight loss. On physical examination abdominal masses and hepatomegaly were detected. Radiological imaging showed widespread masses in the abdominal and thoracic regions. Upper gastrointestinal endoscopy identified an umbilicated protruded lesion with central dark pigmentation at the antro-fundic junction. Histopathological examination and immunohistochemical staining were consistent with melanoma. A subsequent rigorous skin examination uncovered a primary malignant skin melanoma. Due to worsening general condition, the patient received palliative hospice care. Conclusion This report highlights the critical need for vigilant skin examination when encountering gastric lesions with dark pigmentation, which led to the identification of initially undetected cutaneous melanoma.