Primary malignant melanoma of the esophagus:A case report

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 dys-phagia during the previous month. Endoscopic evaluation revealed an eccentric,soft esophageal lesionlocated 25-35 cm from the incisors,which appeared asa protrusion of the esophagus wall,with active bleeding. Biopsies were acquired. Tissue evaluation wascompatible 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 ma-lignant 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 orepigastric discom fort or pain,melena or hemate mesishave also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion,with variablesize,usually pigmented. The neoplasm occurs in thelower 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,chemohormon otherapy,radiotherapy and immunotherapy,with or without surgery,wereused with variable efficacy. The prognosis is poor;themean survival after surgery is less than 15 mo.