Differential diagnosis of anemia in 88 years old: Unexpected findings and geriatric dilemmas

We report a case of functionally independent and cognitively intact 88-year-old male, suffering from anemia with suspicion for UGI bleeding. Diagnostic evaluation revealed a small bowel tumor as the source of bleeding. Our presentation will include a discussion about small bowel tumors as a relatively rare entity. The patient was operated on and the tumor was diagnosed as a distant metastasis of melanoma. Further evaluation revealed a relatively small primary melanoma tumor on the posterior part of right heel. The patient was not aware of the tumor until the diagnostic investigation. Radical Surgery was proposed as the choice of treatment with high probability of wheelchair-bound state as the functional outcome. Further discussion is related to the dilemma of choosing between aggressive treatments versus preserving quality of life in elderly persons. Modern options of melanoma treatment and their suitability to the elderly patient are presented together with a review of the literature.