Abnormal uterine bleeding as a presenting sign of metastasis to the endometrium in a patient with a history of cutaneous malignant melanoma.

BACKGROUND: Metastatic melanomas to the uterus are very rare; to our knowledge, only 11 cases have been reported to date. CASE: A 39-year-old multigravid woman with a history of cutaneous malignant melanoma presented with abnormal uterine bleeding. Histopathologic study of the endometrial biopsy showed neoplastic cells containing brown granular pigment among the endometrial glands suggesting melanoma. Immunohistochemical studies demonstrated intense reactivity of tumor cells for S-100 protein and HMB-45 confirming the diagnosis of endometrial metastatic malignant melanoma. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling were performed. Final pathology examination revealed malignant melanoma limited to the endometrium.
CONCLUSIONS: Abnormal uterine bleeding in patients with a history of malignancy should always alert the physician to consider the diagnosis of metastatic spread to the genital tract.