Esophageal Melanocytosis in African American Male

Abstract

Esophageal melanocytosis is usually regarded as a benign finding with potential progression to malignant melanoma, Endoscopic surveillance has been suggested to prevent disease progression. We describe a case report with incidental finding of esophageal melanocytosis during an upper endoscopy. A 64-year-old African American male with a past medical history of GERD, erosive esophagitis and chronic hepatitis C was admitted for workup of anemia. He was noted to have guiac positive stool without any overt symptoms of bleeding. On admission, vital signs were stable and physical examination was unremarkable. Prior endoscopic workup included negative colonoscopy, multiple upper endoscopies for gastric ulcers, erosive esophagitis and portal hypertensive gastropathy. After negative routine blood workup to diagnose anemia, an upper endoscopy was performed. He was noted to have a discolored patch of mucosa in the posterior pharynx extending into epiglottis and proximal esophagus. Gastric and duodenal biopsies showed chronic inflammation. Biopsy from esophagus showed esophageal squamous mucosa with benign melanin staining cells in the basal epithelium. Histological pattern was consistent with benign melanocytosis. Esophageal melanocytosis is a rare, benign condition, with unclear etiology and pathogenesis. There seems to be an association with chronic inflammatory stimuli like acid reflux and heavy alcohol consumption. Some studies report association with conditions like esophageal squamous cell carcinoma, Laugier-Hunziker syndrome, Addison's disease, oral melanoma. 25 to 30% of surgical specimens of primary malignant melanoma showed melanocytosis indicating that it could be a precursor of melanoma. Histologically, esophageal melanocytosis is characterized by proliferation of melanocytes in the basal layer of squamous epithelium with melanin deposition in mucosa. The lesions should be differentiated histologically from blue nevus or malignant melanoma. It commonly found in mid to lower esophagus, but our patient had involvement of proximal esophagus. Esophageal melanocytosis is assumed to be a benign condition without need for surveillance or follow-up with further endoscopies and biopsies. Without definitive evidence for ongoing surveillance, our patient was treated for gastritis/esophagitis with Proton pump inhibitors and discharged home. To date, there is no clear and definitive evidence of progression of Esophageal melanocytosis to melanoma.Figure 1Figure 2Figure 3