Superficial Primary Malignant Melanoma of the Esophagus Detected and Treated at Stage 0

Abstract

The patient was a 79-year-old male. At three years and eight months after his initial presentation, upper gastrointestinal endoscopy revealed a black-flattened elevated lesion in the middle third of the esophagus, which was diagnosed as malignant melanoma on biopsy. No lymph node or distant metastasis was found. A diagnosis of cT1bN0M0 Stage I was thus made. We performed a robot-assisted, minimally invasive esophagectomy and D2 dissection. The postoperative diagnosis was pT1a-MM, N0, M0, vascular invasion+, stage 0. The patient was recurrence-free for 14 months after surgery. We presume that an aggressive biopsy diagnosis is important for the early detection of malignant melanoma.

Keywords: Stage 0; esophageal malignant melanoma; esophageal melanosis; primary malignant melanoma.

Figure 1.

The lesions are flatter and lighter in color due and the vascular permeability is relatively good.

Figure 2.

a: Observed from incisor row 25 cm. b: Observed from incisor row 28 cm. Close examination of the upper gastrointestinal endoscopy revealed a map-like black-flattened lesion extending 27-34 cm from the incisor row. The black mucosa was partially interspersed with the dark brown mucosa.

Figure 3.

Iodine staining showed that the lesion was not stained, and the “tatamime” sign of the lesion itself was partially irregular and thickened (red arrowhead).

Figure 4.

a: Hematoxylin and Eosin staining showed atypical cells with melanin deposition centered on the basal portion of the stratified squamous epithelium, and junctional melanocytic activity was found. b: Melan-A staining also showed increased positive cells in the basolateral to middle layers of the epithelium.

Figure 5.

Elastica van Gieson staining revealed atypical cells in the vein (yellow arrowheads).

Figure 6.

Primary esophageal malignant melanoma (red lines indicate lesions) [pT1a-MM, pN0, cM0, Stage 0, infiltrative growth, ly0 (D2-40), v1a (Elastica van Gieson staining), pIM0, pPM0 (15.6 mm), pDM0 (40+100 mm), pRM0].