This report describes a new case of primary malignant melanoma of the esophagus (PMME) and reviews the recent literature. A 66-year-old Japanese woman with loss of appetite was examined by endoscopy, and a pigmented polypoid mass about 1.0 cm×1.0 cm in size in the lower third of the esophagus was detected, identified by biopsy as a malignant melanoma. No pigmented lesions of the skin or eyes, rectum, or elsewhere were observed and a diagnosis of PMME was made. A sub-total esophagectomy was carried out and 9 months after surgery the patient was found to have metastases, which had become very progressive.This case had an extremely poor prognosis despite various therapeutic efforts. PMME is a rare neoplasma, with only 238 cases having been reported in the overseas literature through 2002, and 198 cases reported inJapan through 2003. Although characterized by an aggressive biological behavior, for cases in Japan, esophagectomy can result in a 5-year survival rate of up to 30.7%.
Primary malignant melanoma of the esophagus is a rare type of malignant neoplasm, with an extremely poor prognosis. We describe our experience with a patient who had a primary malignant melanoma arising in the esophagus. A 76-year-old woman felt something stuck in her throat while eating at the beginning of February 2002. A dark-blue protruding lesion was found in the gastroesophageal junction by a local physician, and the patient was referred to our department for further evaluation. Physical examination revealed no abnormal pigmentation of the skin, eyegrounds, oral cavity, or anus. Upper gastrointestinal endoscopy disclosed a dark-blue protruding lesion (2 cm in diameter) at the gastroesophageal junction. Malignant melanoma of the esophagus was diagnosed by biopsy. On March 24, 2002, lower esophagectomy and total gastrectomy were performed by means of a left thoracoabdominal incision. The melanoma was classified as stage I on the basis of operative findings (no arterial invasion, no lymph node metastasis, no distant metastasis, and no portal invasion). Examination of the resected specimen revealed a dark-blue lesion (3 × 2 × 1.7 cm) at the gastroesophageal junction. Histopathological findings established the diagnosis of malignant melanoma.