Primary malignant melanoma of the esophagus: A case report

Abstract

The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dysphagia during the previous month. Endoscopic evaluation revealed an eccentric, soft esophageal lesion located 25-35 cm from the incisors, which appeared as a protrusion of the esophagus wall, with active bleeding. Biopsies were acquired. Tissue evaluation was compatible with a melanoma. After excluding other sites of primary neoplasm, the definitive diagnosis of Primary Malignant Melanoma of the Esophagus (PMME) was made. The patient developed a hospital-acquired respiratory infection and died before tumor-directed treatment could begin. Primary malignant melanoma represents only 0.1% to 0.2% of all esophageal malignant tumors. Risk factors for PMME are not defined. A higher incidence of PMME has been described in Japan. Dysphagia, predominantly for solids, is the most frequent symptom at presentation. Retrosternal or epigastric discomfort or pain, melena or hematemesis have also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion, with variable size, usually pigmented. The neoplasm occurs in the lower two-thirds of the esophagus in 86% of cases. PMME metastasizes via hematogenic and lymphatic pathways. At diagnosis, 50% of the patients present with distant metastases to the liver, the mediastinum, the lungs and the brain. When possible, surgery (curative or palliative), is the preferential method of treatment. There are some reports in the literature where chemotherapy, chemohormonotherapy, radiotherapy and immunotherapy, with or without surgery, were used with variable efficacy. The prognosis is poor; the mean survival after surgery is less than 15 mo.

Metastatic malignant melanoma of the oesophagus, first case diagnosed by endoscopic ultrasound‐guided fine needle aspiration

“…The characteristic endoscopic finding in primary malignant melanoma is the presence of a polypoidal lesion of mucosa, usually pigmented . In 1953, Allen and Spitz established the histological criteria for the diagnosis of metastatic as opposed to primary melanoma.…”

Primary malignant achromic melanoma of the lung

“…However, the possibility of a primary adrenal melanoma with solitary lung metastasis cannot safely be ruled out, even though primary adrenal melanoma is even rarer than PLM . Other unusual primary visceral sites have been reported, including the meninges, the esophagus, the oral‐nasopharynx, anal canal, rectum, stomach, small bowel, gallbladder, and large bowel, the uterine cervix, the ovary and the kidney…”

Huge primary malignant melanoma of the esophagus: A case report and literature review

“…Primary malignant melanoma of the esophagus (PMME) is a relatively rare esophageal malignancy accounting for 0.1–0.2% of all esophageal tumors and is accompanied by a poor prognosis . Here we report a huge malignant esophageal melanoma case admitted and treated with surgery in June 2012, combined with a literature review.…”