Palliation of a primary malignant melanoma of the distal esophagus by stent implantation. Report of a case.

Abstract

A 55-year-old woman suffering from progressive dysphagia, retrosternal pain, and annoying foetor ex ore is described. Esophagogastroscopy showed a dark, necrotic tumor extending from 28 cm below the front teeth to the esophagogastric border, and biopsy showed it to be a primary malignant melanoma. The underlying progressive tumor stage with pericardial infiltration and intra-abdominal lymph node metastasis precluded the possibility of curative surgical treatment. For palliation, we implanted a metal stent (Ultraflex, Microvasive, Boston Scientific Corporation, Watertown, MA, USA) in the distal esophagus to alleviate the dysphagia. Permanent recanalization of the tumor-obstructed esophagus by stent implantation alleviates symptoms, thereby significantly improving quality of life. Radiochemotherapy can be performed despite the presence of the stent. Surgery is the therapy of choice for resectable primary malignant melanoma of the esophagus. Endoscopic therapy should be considered for alleviating dysphagia if surgery is impossible.