Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin) confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic) rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen. 1. Introduction Splenomegaly is defined when the length of spleen of a mature person is more than 12？cm. Symptoms of splenomegaly may include abdominal pain, chest pain, back pain, early satiety, anemia, and palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by Castell’s sign or Traube’s space but an ultrasound can be used to confirm the diagnosis. Causes of splenomegaly are spherocytosis, thalassemia, hemoglobinopathy, nutritional anemia, early sickle cell anemia, immune hyperplasia, mononucleosis, AIDS, viral hepatitis, subacute bacterial endocarditis, lymphoma, and melanoma metastasis to the spleen. According to a report, the lung cancer, cutaneous malignant melanoma, and breast cancer are the most frequent sources of splenic metastases, respectively [1]. Melanoma, an important splenic metastatic tumor, is a tumor of melanocytes which are found predominantly not only in skin but also in the bowel and the eyes. It is one of the less common types of skin cancers but causes the majority (75%) of skin cancer-related deaths. Melanocytes are normally present in skin, being responsible for production of the dark pigment melanin. According to some of the previous reports, melanoma causes splenomegaly and in rare instances spontaneous splenic rupture [2, 3]. There have been several reported cases of splenic rupture in leukemia [2, 4].
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