A Rare and Rapidly Progressive Case of Primary Esophageal Malignant Melanoma in an Elderly Patient

Primary malignant melanoma of the esophagus (PMME) is a rare malignancy typically associated with poor prognosis, particularly in elderly patients. Here, we present the case of an 85-year-old female patient with a three-month history of progressive dysphagia and heartburn-related epigastric pain. Endoscopy revealed a polypoid esophageal lesion, confirmed as melanoma via biopsy with positive immunohistochemical staining for Melan-A and SOX-10. Given her age, frailty, and comorbidities, she was deemed unfit for surgery. A palliative approach, focusing on symptom management and systemic therapy, was adopted. Unfortunately, her condition rapidly worsened, leading to severe malnutrition and emaciation. The treatment focus shifted exclusively to symptomatic relief and best supportive care, and she ultimately passed away six months after diagnosis. PMME is rare and its diagnosis is challenging, especially in elderly patients; this case emphasizes the importance of individualized treatment plans. Early detection remains difficult due to the asymptomatic nature of early-stage disease. Treatment strategies are limited and should be carefully individualized, particularly in older patients, where the risks of aggressive intervention may outweigh potential benefits. In this group of patients, the emphasis should be placed on quality of life rather than curative intent.