Case Report
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2011; 17(42): 4734-4738
Published online Nov 14, 2011. doi: 10.3748/wjg.v17.i42.4734
Primary malignant melanoma of the esophagus: A case report
Joana Machado, Paula Ministro, Ricardo Araújo, Eugénia Cancela, António Castanheira, Américo Silva
Joana Machado, Paula Ministro, Ricardo Araújo, Eugénia Cancela, António Castanheira, Américo Silva, Department of Gastroenterology, S Teotónio Hospital, 3504-509 Viseu, Portugal
Author contributions: Machado J contributed to literature review and wrote the manuscript; Ministro P contributed to the endoscopic diagnosis and revised the manuscript; Cancela E and Castanheira A contributed to the follow up of the patient; Araújo R and Silva A contributed to literature research.
Correspondence to: Joana Machado, MD, Department of Gastroenterology, S Teotónio Hospital, Av Rei D Duarte, 3504-509 Viseu, Portugal.
Telephone: +351-232-420500 Fax: +351-232-282190
Received: January 23, 2011
Revised: April 19, 2011
Accepted: April 26, 2011
Published online: November 14, 2011

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.

Keywords: Esophagus, Melanoma, Esophagoscopy, Upper gastrointestinal tract, Neoplasms