According to literature search, 8 cases reported so far and total 9 cases including our case, of which, virtually all the patients presented with painless jaundice
(7/9) (Table 1) and had proven primary cutaneous or vaginal melanoma at the time of diagnosis of GI metastasis (7/9).
Common symptoms can include painless jaundice
(yellow skin/eyes, dark urine) related to bile duct obstruction, significant and unexplained weight loss and abdominal discomfort When eventually diagnosed, most sufferers find they have untreatable terminal cancer.
A 67 year old man was admitted to hospital after a 5-day period of painless jaundice
, pruritus, dark urine and light stools.
A 65-year-old woman was seen because of a 7-year history of intermittent painless jaundice
Table 1 shows that nearly 70% of patients who had malignancy had painless jaundice, with or without common bile duct gallstones.
and %) of patients Gallstones/ Presentation Gallstones Malignancy malignancy Painless jaundice 14 (24%) 15 (68%) 9 (69%) Pain and jaundice 9 (15%) 5 (23%) 1 (8%) Charcot's triad 7 (12%) 0 0 Abdominal pain only 13 (22%) 1 (5%) 1 (8%) Non-specific 11 (19%) 1 (5%) 1 (8%) Coincidental 5 (8%) 0 1 (8%) Total 59 22 13
Painless jaundice was present in 14 (24%) of the gallstones-alone group, while non-specific presentation occurred in 11 patients (19%): five had malaise and failure to cope at home, four had confusion and two were generally unwell.
The classical presentations for common bile duct stones of abdominal pain, with or without jaundice and Charcot's triad occurred in only half the patients, whereas painless jaundice and a non-specific presentation occurred in 25 patients (43%), supporting the view that the presentation of gallstones is often atypical in elderly patients.
, often described as the classic presentation of pancreatic cancer, occurred in a minority (18%) of patients.