Post written by Prapimphan Aumpansub, MD, from the Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.  

A 67-year-old woman presented with progressive jaundice and passage of melena for 2 months. She had a history of malignant melanoma of the left flank which was completely resected 2 years earlier. ERCP was performed, and single-operator digital cholangioscopy showed a dark brownish hemorrhagic tumor at the distal common bile duct (CBD). Histopathologic readings confirmed the diagnosis of metastatic malignant melanoma to the CBD.

Melanoma is a malignant tumor that rarely metastasizes to the biliary system. In this case, we detected the metastasis of malignant melanoma to CBD and demonstrated the typical dark color of the tumor under endoscopic exam by using single-operator digital cholangioscopy.

Figure 1. A, CT view showing an enhancing intraductal mass 3.8 cm long at the distal common bile duct, causing upstream biliary dilatation. B, Cholangiogram showing an irregular filling defect measuring 4 cm in length at distal common bile duct. C, Single-operator digital cholangioscopic view showing a large irregular brownish intraductal papillary mass at distal common bile duct. D-G, Histopathologic confirmation of diagnosis of malignant melanoma including pleomorphic, loosely cohesive cells with enlarged, hyperchromatic, and irregular nuclei of the tumor (D, arrow, H&E, orig. mag. ×400) containing brown pigment (E) with positive staining for HMB-45 (orig. mag. ×1000) (F) and Melan-A (orig. mag. ×100) (G) protein (orig. mag. ×100).

Although metastasis malignant melanoma to the CBD is extremely rare (about 10%), the possibility of metastatic melanoma to the extrahepatic biliary tree should be excluded in patients presenting with obstructive jaundice who have a known history of malignant melanoma.

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