Abstract
BackgroundPrimary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis. There are few reports of early-stage cases in which tumor invasion reached the lamina propria or muscularis mucosae, as in the present case. A standard treatment for early-stage PMME has not yet been established. The present study aimed to summarize previous reports and to discuss the indications for surgical treatment of early-stage primary malignant melanoma of the esophagus.Case presentationA 70-year-old woman with PMME was referred to our hospital. She underwent thoracoscopic and laparoscopic subtotal esophagectomy with lymphadenectomy. The resected specimen showed melanocytosis and junctional activity. Melanoma-specific antigens melan-A, S-100, and HMB45 were detected by immunohistochemical staining. The pathological diagnosis was pT1a-MM, pN0, pM0, and pStage IA. She remains alive without evidence of recurrence 39 months later.ConclusionSubtotal esophagectomy with regional radical lymphadenectomy could be recommended to patients with early-stage primary malignant melanoma of the esophagus, and curative surgical resection could improve their prognosis.
Highlights
Primary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis
Subtotal esophagectomy with regional radical lymphadenectomy could be recommended to patients with early-stage primary malignant melanoma of the esophagus, and curative surgical resection could improve their prognosis
Given that PMME is a rare disease with a poor prognosis, an appropriate treatment of choice for PMME is still under investigation
Summary
Primary malignant melanoma of the esophagus (PMME) is a rare disease. The incidence of PMME in all esophageal malignancies is low at 0.1%–0.2% [1]. Esophagogastroduodenoscopy (EGD) revealed an elevated lesion 35 cm from the incisors that was diagnosed as malignant melanoma by biopsy. She was referred to our institution for further examination and treatment. Detailed clinical examination of the eyes, oral cavity, nose, and skin did not indicate any malignant melanoma lesions Based on these findings, the preoperative diagnosis of the lesion was PMME without metastasis (cT2N0M0, cStage II) according to the UICC TNM classification of esophageal cancer [3]. The resected specimen showed an elevated, black, and pigmented polyp-like lesion (15 mm × 13 mm × 9 mm) in a flat and pigmented area (57 mm × 38 mm) (Fig. 4a). She has been followed up once a half year and underwent blood tests and contrast-enhanced CT to search for metastasis or recurrence
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