Esophageal melanosis: Two case reports and review of literature

Abstract

Background: Esophageal melanosis (EM) is a rare condition characterized by melanin pigmentation in the esophageal mucosa. It is not well understood and has been documented in less than 100 cases worldwide.

Case summary: We report two cases of African American patients who complained of significant weight loss (over 20 pounds in approximately six months) and abdominal pain during their first visit. The first case involves a 54-year female with a history of hepatic steatosis and polysubstance abuse, who also experiences nausea and vomiting. The second case is a 59-year-old male with hypertension and gastroesophageal reflux disease (GERD), who was diagnosed with esophageal squamous cell carcinoma. Both cases show benign melanocytes in the basal layer on the esophagus biopsy and are diagnosed as EM.

Conclusion: It is important to note that EM has been associated with malignancies such as carcinoma and melanoma. Therefore, accurate diagnosis and appropriate management are crucial. Patients with EM, especially those with concurrent risk factors (e.g., GERD, smoking), should be carefully monitored for any signs of malignancy.

Keywords: Case report; Esophageal melanosis; Esophagus; Gastroesophageal reflux disease; Melanoblasts.

Figure 1

Imaging examinations. A: Endoscopic poorly delineated pigmented lesion (arrow) on the mucosa; B and C: Hematoxylin and eosin stain shows basal cell hyperplasia, intercellular edema, and presence on non-atypical cells with melanin deposition (arrow) along the basal layer of the epithelium, 10 × and 40 × magnification; D: SRY-related HMG box 10 immunohistochemistry red nuclear positivity in the melanocytes.