Pseudomelanosis of the upper gastrointestinal tract is a rare diagnosis of undetermined significance, most commonly affecting the duodenum. Endoscopically, it is characterized by dark spickled pigmentation . Its development has been linked to certain conditions and medications. Involvement of the stomach is extremely rare with very few cases reported in the literature to date. We report an 85-year-old male who is known to have type 2 diabetes mellitus, dyslipidemia, iron deficiency anemia, and chronic kidney disease who underwent an esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleeding and was found to have gastric and duodenal pseudomelanosis confirmed by biopsy. It is an extremely rare benign condition, but metastatic melanoma has to be ruled out, as was done in this case.
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