Primary malignant melanoma of the esophagus: misdiagnosis and review of literature.

A 48-year-old man presented with retrosternal pain after eating. This problem had persisted for about 7 days. The pain typically disappeared within a few minutes but recurred every time the patient tried to eat. No dysphagia, hematemesis, melena, or weight loss was observed. Upon esophagoscopy, several black lesions were observed. They were scattered throughout the middle esophagus (Fig. 1A). Proton pump inhibitors were found to partially alleviate the retrosternal pain. Because the doctor who treated the patient was unfamiliar with primary malignant melanoma of the esophagus (PMME), the patient was discharged after symptoms disappeared, without receiving any further therapy. Eight months later, the patient presented again with dysphagia. A second esophagoscopy showed that the lesions had become larger in size (Fig. 1B). A biopsy was required. Endoscopists believed that the bottom of the lesion was vascular, so the biopsy was not performed for fear of causing bleeding. Surgery and pathological examination were performed instead (Figs. 2 and 3). Some cancerous tissue was found in the esophageal residual end but no lymph node invasion. Three months after surgery, the patient died because of systemic metastasis.