Abstract
A 70-year-old man was referred to our hospital on suspicion of esophageal malignant melanoma.
Biopsy of the melanosis was performed by endoscopy. Pathological findings suggested malignant melanoma.
Endoscopic examination showed a black, flat, elevated lesion with a diameter of 10mm. CT and PET findings showed no evidence of lymph node or distant metastases. No pigmented lesions in the skin or eyes were observed. We conducted endoscopic submucosal dissection (ESD) for the purpose of total biopsy. Atypical cells that contained melanin granules, resulting from the basal layer, were observed histologically to infiltrate into the lamina propria and mucosal epithelium (junctional activity). They were positive for S-100 and MELAN-A by immunostaining. He was diagnosed with malignant melanoma of the esophagus because there was no evidence of systemic malignant melanoma of the skin or mucous membranes.
The tumor had invaded the lamina propria and the tumor specimen had negative margins without lymphatic invasion or vascular invasion. Although we recommended additional surgical resection, because the patient refused surgery, he is currently under observation without treatment. Although 10 months have passed after endoscopic surgery, there is no evidence of recurrence.
In this case, resection of esophageal malignant melanoma by ESD was possible because it had been discovered at a very early stage during follow-up of esophageal melanosis.
