Primary Malignant Melanoma of the Esophagus: A Case Report

Introduction Primary malignant melanoma of the esophagus (PMME) is a rare and aggressive cancer, typically originating from the skin, uvea, or retina. Due to its poor prognosis, early detection and intervention are critical. Surgical resection remains the standard treatment for this disease [1,2]. Case Presentation A 69-year-old male was diagnosed with PMME in February 2018, with no evidence of metastasis. Three months later, he underwent minimally invasive esophageal resection (MIE) and gastric conduit formation via a combined laparoscopic and thoracoscopic approach. Histopathology confirmed esophageal melanoma with a 3.23 mm depth of invasion and no lymphovascular involvement. On the second postoperative day, gastric conduit necrosis was diagnosed. The patient was reoperated, and an esophagostomy and gastrostomy were formed. Six months later, the patient underwent reconstructive esophageal surgery with gastric interposition. Although the initial surgery was successful, a fistula developed at the anastomosis site, which was managed with a stent. The patient was discharged with a small residual fistula at the junction. The stent did not fully cover the defect due to its high position, and the patient was readmitted for further management. One month later, the stent was removed, and X-rays confirmed no leakage or fistula. The patient was discharged without further complications. Discussion PMME is an extremely rare entity, accounting for only 0.1–0.2% of all esophageal malignancies [2]. Surgical resection is the most effective treatment but carries significant risks. One such complication is gastric conduit necrosis, which occurs in around 1-10% of patients undergoing esophageal reconstruction with gastric conduit [3,4]. The average survival period of PMME after diagnosis is about 10–14 months, with a 5-year survival rate of 4.2%. Early detection and surgical intervention are crucial to improving long-term outcomes [5]. Conclusions Primary malignant melanoma of the esophagus requires early and aggressive surgical intervention for optimal outcomes [1]. Despite significant surgical challenges and postoperative complications, the patient achieved a stable outcome and remains free of melanoma five years after surgery, demonstrating the importance of timely treatment and effective management of postoperative complications.