Oosting et al. Journal of Medical Case Reports 2010, 4:10 http://www.jmedicalcasereports.com/content/4/1/10 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report Sjoukje F Oosting1*, Frans TM Peters2, Geke AP Hospers1, Nanno H Mulder1 Abstract Introduction: We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract. Case presentation: A 52-year-old Caucasian man presented with abdominal pain and distension, malaise, night sweats, dysphagia and early satiety. A computed tomography scan showed massive ascites, lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum. When his skin was re-examined, an irregular pigmented lesion over the left clavicle measuring 15 mm × 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diag- nosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg/m2 every three weeks and he was dis- charged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X- ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U/L to 1827U/L, supporting the conclusion that the response of gastroin- testinal metastases to dacarbazine had resulted in the perforation of the patient’s bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later. Conclusion: Melanoma can originate in, as well as metastasize to, the gastrointestinal tract. Gastrointestinal perforations due to responding tumors are a well-known complication of systemic treatment of gastrointestinal lymphomas. However, as the response rate of metastatic melanoma to dacarbazine is only 10% to 20%, and responses are usually only partial, perforation due to treatment response in metastatic melanoma is rare. Medical oncologists should be aware of the risk of bowel perforation after starting cytotoxic chemotherapy on patients with gastrointestinal metastases. Introduction The incidence of melanoma is increasing worldwide. In The Netherlands 19.4 cases per 100,000 persons were diagnosed in 2005. For the treatment of widespread metastatic diseases, single agent dacarbazine (DTIC) chemotherapy is still the standard of care. Combination regimens with other cytotoxic agents, cytokines and tyr- osine kinase inhibitors do not result in a survival benefit [1-3]. * Correspondence: s.oosting@int.umcg.nl 1Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands Treatment with high-dose interleukin-2 (IL-2) has induced a durable complete remission in a minority of patients with metastatic melanoma, but this treatment is associated with severe toxicity and it is not widely avail- able [4]. Treatment with dacarbazine results in response rates of 10% to 20%. Responses are usually partial and gener- ally last for only four to six months, although prolonged remissions are occasionally seen. A survival benefit of treatment with dacarbazine over best supportive care has not been proven definitively [5]. Compared to other cytotoxic agents, dacarbazine is relatively well tolerated. © 2010 Oosting et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.